2003, 09-10 Permit App: BLD-03-02433 Addition GarageY
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
330,3
23%e:
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 3 a_ X 3
E BUILDING PERMIT
RELOCATION
® CHANGE IN USE C GRADING
Q SIGN Q TENANT
O MANUFACTURED HOME
I] OTHER
OWNER / APPLICANT INFORMATION
f
0 OWNER: "'Pi") A/41/te-Z
APPLICANT: a 6'C 7-7 0/1.1
FAX: 'YJ 97.0'
s4�P.'t G7
CITY, STATE, ZIP
PHONE: FAX: PHONE: 3C 2' W76
ADDRESS: ADDRESS: /�f7
CITY,STATE, ZIP
® ARCHITECT:
°CONTRACTOR:
PHONE:
ADDRESS:
CITY, STATE, ZIP
FAX: PHONE:
WA ST CONTRACTOR LICENSE #
ADDRESS:
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: "---S-V<'
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
1
30% SLOPES ON PROPERTY: /VV
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:c
GARAGE: %°/
COVERED DECK: /U°
DECK: /U.°
MANUFACTURED HOME
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SIGN
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
1
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
FIRE ALARM:
TENT:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
• BOLTING
FIRM NAME:
INSPECTOR(S):
°CONCRETE
0 REINFORCEMENT
PHONE:
0 WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO
IF YES: ▪ COUNTY 0 CITY
IF YES, WHICH WATER DIST/IRR:
1S PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO PSSA: 0 YES 0 NO
DATE: ' STAFF:
METHOD OFPAYMENT;;
O 0
CASH CHECK
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
1
08/28/2003 16:30 FAX 509 625 3320
inianu udruivauyy
4111/ 410111how 4110
8
) ..4
e,
Ni 7'
d 0
co
0
0
cc
a
r\o
/
Z2.
3 303 iv u 1C,.rt,
QSIQ /tow-- ,S4+EAikNt-
Jo /S "4/1-4._ YA2 /1 ova'
(gG0�NU
01-5—y(k
Xr4ucjLe'L _
(vi1AWYl ij yffr/
or
r
6 WI
g y NA''t— c srrftic r•�v
aE L "/ 1r