2004, 10-27 Permit App: BLD-04-08043 Reroofa OWNER: alvp(.241..
PHONE: W- /? 3 /
ADDRESS: /4'S'6/ 1_''
FAX:
CITY,STATE, ZIP
® CONTRACTOR:
a APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
El ARCHITECT:
PHONE: q 93 11A72-2- FAX: PHONE: FAX:
ADDRESS: O6 /AY G a G.. p7.42a./ 6.40 WG-'/ ADDRESS:
/ CITY, STATE, ZIP
G
WA ST CONTRACTOR LICENSE # ' -1 R c J95/ C ONTACT:
CITY, STATE, ZIP
, _J
01 3
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
r
STREET ADDRESS: /7..,-/e5
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: r „i c/
a DUI(LDING.PERMIT . . CCHANGE IN USE • a GRADING •a MAN ACACTURED HOME
E] SIGN 0 -TENANT 13-01-11ER
CI -RELOCATION
OWNER / APPLICANT INFORMATION
1
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 4
30% SLOPES ON PROPERTY:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:
BUILDING DIMENSIONS: CONSTRUCTION TYPE:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
14.24.1
MANUFACTURED HOME
SIGN
WIDTH:
YEAR:
MANUFACTURER:
LENGTH:
PIT SET:
RELOCATION
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SAFETY
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
FIRE ALARM:
TENT:
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
0 BOLTING
FIRM NAME:
INSPECTOR(S):
0 CONCRETE
0 REINFORCEMENT
PHONE:
0 WELDING
FAX:
BUILDING STAFF USE ONLY
1
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO
IS PUBLIC WATER AVAILABLE: ® YES 0 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: 0 YES 0 NO PSSA: 0 YES 0 NO
0
IF YES: COUNTY 0 CITY
DATE:
1
STAFF:
METHOD OF PAYMENT:
0 0
CASH CHECK
BANKCARD #; EXPIRES: VIN #
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD