2003, 09-18 Permit App: BLD-03-02506 GarageCfSiiiierneNtiqk
400.1Valley
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: A/0 y , //,,opro Z, -n e
ASSESSOR'S TAX PARCEL NUMBER(S): 1{ /5` =3. , �7
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
BUH,DING PERMIT . 0 CHANGE IN USE 0 GRADLNG
® LOCATION [SIGN 0 -TENANT
o MANUFACTURED HOME
DOTHER
OWNER / APPLICANT INFORMATION
O OWNERS •i'� r6 / 4•c z
® APPLICANT:
(S PHOND? •4:290? -317% FAX: PHONE:
FAX:
ADDRESSa IUAbj/t4¢q€ S,Gb, 049@C/ tM ADDRESS:
Miler.
bilker /i _ CITY,STATE, ZIP
`moiler b/ulF�er El ARCHITECT.:
CONTRACTOR
PHONE:
CITY, STATE, ZIP
FAX: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: /O 700,
BUILDING HEIGHT TO PEAK: /3
BUILDING DIMENSIONS2Xa 3
'NUMBER OF STORIES: /
NUMBER of BEDROOMS:O
FLANKING SETBACK:
FRONT SETBACK: 3 8
REAR SETBACK: 3
LEFT SETBACK: /0
C
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP•S,,4 Fe"i; /J
CONSTRUCTION TYPE:1)00c/F/'y>Ae.
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
STRUCTURES ON PROPERTY: /As. FINISHED BASEMENT:
CRITICAL AREAS: GARAGE: 5-06 �F
CURRENT PROPERTY SIZE: 7AX 9'9 COVERED DECK:
CURRENT PROPERTY USE:5 '/GMA* DECK:
CURRENT SEPTIC USE: G, $ y
CURRENT WELL USE: C./Y.),
IMPERVIOUS SURFACE AREAd%'f
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT 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
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
0 BOLTING °CONCRETE 0 REINFORCEMENT ' ° WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: CI YES ® NO IF YES: ® COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: 0 YES ® NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED'STORMWATER CONTROL AREA: 0 YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA:• 0 YES NO PSSA: ®YES 0 NO
DATE:
METHOD OF PAYMENT:
® 0
CASH CHECK
STAFF:
o
BANKCARD #; EXPIRES: VIN#
AUTHOR/ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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