2003, 08-18 Permit App: BLD-03-02252 Pole BarnL
Sji
400Valley
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
1
STREET ADDRESS:
35`0
ASSESSOR'S TAX PARCEL NUMBER(S): + 5-0 31e At
LEGALDISCRIPTION: 5� x d `T,142_ v -
PERMIT DESCRIPTION:
U1LDING PERMIT
}RELOCATION
CI CHANGE IN USE D GRADING
(� SIGN Q TENANT
D MANUFACTURED HOME
-OTHER
OWNER / APPLICANT INFORMATION
® OWNER: i �/4 1.6e,,—
PHONE:
FAX:
® APPLICANT: G1 7-10. - S-
PHONE: 2' ? L d S�� . FAX:
ADDRESS: �� I /10,kFl% ,53-7-2c,c=7
CITY, STATE, ZIP
ADDRESS:
CITY,STATE, ZIP
°CONTRACTOR: Cl r54 -2e / 0
q ARCHITECT:
PHONE: -22 f 7 / FAX: PHONE:
ADDRESS:
ADDRESS: L' 9A99 /074x v -'r // IA l/` � S
455-7-6-
Q
� -CITY,. STATE, ZIP
4yb
WA ST CONTRACTOR LICENSE 5 / �`` .f 972 LF
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK: 110
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
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:
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
0 BOLTING
FIRM NAME:
INSPECTOR(S):
0 CONCRETE
0 REINFORCEMENT
PHONE:
0 WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO
IS PUBLIC WATER AVAILABLE: ▪ YES ▪ NO
IF YES: ▪ 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 NO PSSA: 0 YES 0 NO
DATE:
METHOD OF PAYMENT.•
O 0
1
CASH CHECK
BANKCARD A#; EXP/RES: V/N#
AUTHOR/ZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
STAFF:
1
08/1b/2UUJ /1/2niYJdZ417b /
AUG 15 2003 11:09 FR
r
JrcnQ CMJ
TO 3241567 F' •--
v
i3r�Se Pd'rA e-
** TOTAL PAGE.03 **
AUG 15 2003 11:31 5093241567 PAGE.02
na/ 1C/ LGGJ 1G:4.7
JG7JL41J0
FINAL ..AS18Ui6 .INSTqtIAi101V
tcrCA''TION OF THE ON-SITE S!'4'1
ise
$YMTEM REPRESENTED BY THE DRAW
IS NOT TO BE CONSTRUED A5.404
EXACT LOCATION OF THE SYSTIM,
REMARKS (continued)'
•
AUG 15 2003 10.44
5093241567 PAGE.01
N
APPROVED B
o
q
1� /A/
3rtS C'J,, Avo_