2005, 03-03 Permit App: 05000649 Demo ResidenceSpolane
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BU/LD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
722-3 Z-_ -aw Eiry
5519173.
ASSESSOR'S TAX PARCEL NUMBER(SI:
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 10 f 144 DL(f p -r•-- P"7 F w7/ 110 Gk." •
® BUILDING PERMIT ® CHANGE IN USE O GRADING ® MANUFACTURED HOME
®RELOCATION CISIGN CITENANT
0 OTHER
OWNER / APPLICANT INFORMATION
pyyryER: �c/"\. L.- Girt
` t
(�- 1D �/ APPLICANT:
PHONE: l C V VdFAX:
¢ PHONE:
ADDRESS: ! 72_2_3 t. Oh/f rGf ADDRESS:
CITY,STATELZIP CITY, STATE, ZIP
°CONTRACTOR: S/42'v7 C ® ARCHITECT:
PHONE: FAX: PHONE:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
3,47,4,_a
FAX:
FAX:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: UNFIN BASEMENT:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
FLANKING SETBACK: CURRENT. PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: - IMPERVIOUS SURFACE AREA: -
-11001.1111111111111
j
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
- SQ ET OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
i
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
a BOLTING
FIRM NAME:
INSPECTOR(S):
°CONCRETE
® REINFORCEMENT
PHONE:
a WELDING
FAX:
1
i
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE:CI
YES ® NO
IS PUBLIC WATER AVAILABLE: 0 YES a NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: a YES 0 NO PSSA: 0 YES 0 NO
IF YES: ▪ COUNTY • CITY
p DATE:
I STAFF:
METHOD OF PAYMENT:
O a
CASH CHECK
a
BANKCARO #; EXPIRES: VIN #
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD