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2004, 09-29 Permit App: BLD-04-07806 Pole Bldg
e jvdley PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUNITY DEVELOPMENT BUILD/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: 70g _ 1 "`oea)w ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: PERMIT DESCRIPTION: BUILDING PERMIT RELOCATION ® CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME (SIGN QTENANT DOTHER OWNER / APPLICANT INFORMATION OWNER: J a /I N fr if icrl PHONE: 1 4-� ! ©l FAX: ADDRESS: 7"-s- /Llaf�'R8),v°,dZIP CITY -R ,STATE, ® CONTRACTOR: PHONE: ADDRESS: CITY, STATE, ZIP FAX: 1 APPLICANT: 56.44 PHONE: FAX: ADDRESS: CITY, STATE, ZIP ARCHITECT: PHONE: FAX: ADDRESS: CITY, STATE, ZIP AST CONTRACTOR LICENSE N CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT: q [ �D• BUILDING HEIGHT TO PEAK: 13 BUILDING DIMENSIONS:3 I Y30 NUMBER OF STORIES: NUMBER of BEDROOMS: /n FLANKING SETBACK: o FRONT SETBACK: REAR SETBACK: LEFT SETBACK: / q 1 6/ 30% SLOPES ON PROPERTY: OCCUPANCY GROUP: CONSTRUCTION TYPE: STRUCTURES ON PROPERTY:�t/ CRITICAL AREAS: /" CURRENT. PROPERTY SIZE: CURRENT PROPERTY USE: CURRENT SEPTIC USE: CURRENT WELL USE: RIGHT SETBACK: 2(-5 IMPERVIOUS SURFACE AREA: 1 MAIN FLOOR SQ FT: 2ND FLOOR SQ FT: UNFIN BASEMENT: FINISHED BASEMENT: GARAGE: • COVERED DECK: DECK: MANUFACTURED HOME SIGN WIDTH: YEAR: LENGTH: 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: PAINT BOOTH: FIREWORKS DISPLAY: BLASTING: FIRE ALARM: TENT: 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 FIRM NAME: INSPECTOR(S): OCONCRETE 0 REINFORCEMENT PHONE: 0 WELDING FAX: 1 1 BUILDING STAFF USE ONLY 1 1 IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IS PUBLIC WATER AVAILABLE: 0 YES ® NO IF YES: 0 COUNTY ® CITY IF YES, WHICH WATER DIST/IRR: IS 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: METHOD OF PAYMENT: 1 STAFF: 0 0El dm CASH CHECK 0 VISA BANKCARD #; EXP/RES: VIN# AUTHORIZED SIGNATURE.: *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD (is Tr 0 e S. - //D r r o r.✓ RCS' 61 3 do 1 /s,,3 • 1,.3 rr r PLANNING DEPT. APPROVED BY* DATE: ADDRE$S,JZQ._a. 5- M pul ZONE LAC 5 3 - Q nen FRONT f RANKING Scq /e7 _ lLt COMMENTS 1 -SI /<- [� REVIEWED BY 44,, 1/43 L 6 , 1 ) V2. q 5t - 2 e f a A, P 4) rt o-2 c r 4 r This sb plan is being submitted for the purpose of 0' obtandng a erg permit and is s true and comet mer of the propaW. Alt known property linesidlinensions. curb lines, structures and easements have been Identified. Also Indicated are wetlands. bodies a dopes or alar Sig: g a7-62114 Oro penc. Mee- tAg / F'o /OZgT/O H O� h t c[ r4 [ e /n Pg/pt.Of O ne�abov tic? Lo Ts