2004, 07-29 Permit App: BLD-04-07188 Garage Addition1
Saw
,Walley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave SM 106
Spokane Valley, WA 99206 .,
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: e,7 /e/z gva J�
ASSESSOR'S TAX PARCEL NUMBER(S):
7e/ 0202
LEGAL DISCRIPTION: /ue/g5-�- 'Pjy (fir 1-2 62
,PERMIT DESCRIPTION: _
gG�
BTJ1I.DJ7 GPERNIIT
QRELOCATION
/,-44l/(%:Y ff/
l
• ®CHANGE IN USE • D GRADING
(]-SIGN O TENANT
0 MAN'IiFACTURED HOME
}OTHER
OWNER / APPLICANT INFORMATION
® OWNER: ( z, thn ® APPLICANT: D/.)
PHONE: gG l ✓ 7L/ FAX:
�J PHONE: � FAX:
Q
ADDRESS: b/ /51Z 2 A 5 ale ZCS
0
CITY,STATE, ZIP -
CONTRACTOR:aLt/j�il /a(..,& /Ai 0
PHONE: 6:547/ 4 /13 FAX&O7t1 & r u%Y{K)
ADDRESS: 707 /L A - .k W.
�/J CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # ' `o,e,%%t "/O33.27
ADDRESS:
CITY, STATE, ZIP
ARCHITECT: ®GF%cJL�
PHONE:
FAX:
ADDRESS: - -
CONTACT:
PERMIT/BUILDING INFORMATION
a
COST OF PROJECT: ����
BUILDING HEIGHT TO PEAK:
/
BUILDING DIMENSIONS: 1 X22
'NUMBER OF STORIES:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP: � -
CONSTRUCTION TYPE:WOOD F2616
1
qq STRUCTURES ON PROPERTY: A
NUMBER of BEDROOMS: :J CRITICAL AREAS:
FLANKING SETBACK: - _ CURRENT PROPERTY SIZE:,
FRONT SETBACK: 10:6/ CURRENT PROPERTY USE;c,ie%fT
REAR SETBACK: 16/ CURRENT SEPTIC USE: 4j'
LEFT SETBACK: CURRENT WELL USE:
yyi c/
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
CITY, STATE, ZIP
Dc
MAIN FLOOR SQ FT:
2N0 FLOOR SO FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
MANUFACTURED HOME . , SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
5Q FT OF SIGN: HEIGHT OK SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
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 ❑CONCRETE 0 REINFORCEMENT " 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: CI YES ® NO IF YES: 0 COUNTY ® CITY -
IS PUBLIC WATER AVAILABLE: ® YES 0 NO IF YES, WHICH WATER DIST/IRR:
I5 PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES ❑ NO PSSA: ❑ YES 0 NO
DATE: ' STAFF:
METHOD OFPAYMENT.•
0
CASH CHECK
❑
BANKCARDA'• EXPIRES: V/N#
AUTHOR/ZED SIGNATURE
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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