2003, 11-19 Permit App: BLD-03-03103 GarageCITY
.0,0Valley
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:
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
ICA
PERMIT DESCRIPTION:
role- L'AfLr\ Ca
'BUILDING PERMIT CI CHANGE EN USE D GRADING D
RELOCATION MANUFACTURED HOME
0 SIGN D TENANT
0 -OTHER •
OWNER / APPLICANT INFORMATION
0 OWNER: fu a_ ��17me.,S
0
® APPLICANT:
PHONEeccA -` --E _7-19 FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE, ZIP
CITY, STATE, ZIP
CONTRACTOR: SJ A `cam ��`��2- \�S S'��, . ii.A.-,kkja ARCHITECT:
PHONE: S�l �1�� `'lbG`1 FAX: SCS �i�� t -� tisr? PHONE: L \ - \C -1-C-1 I
FAX: S�� - �l Q:AL
ADDRESS: •(-1\ CDS VAI, -( .1,1 ADDRESS:ti5�-1 E 3(.3
3 \cf1at
CITY, STATes ZIP - CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #}SSS j b SIC JJ -2 CONTACT: riAe...�
1
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
30%SLOPES ON PROPERTY: 1-3C)
MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: IV OCCUPANCY GROUP: -- 2N0 FLOOR SQ FT:
BUILDING DtMENStONS: (o I OCONSTRUCTION TYPE: ?O)-, 64.113.-C1 UNFIN BASEMENT:
NUMBER OF STORIES: ,.-' STRUCTURES ON. PROPERTY: -1lo - FINISHED BASEMENT:
NUMBER of BEDROOMS: , -- -----
CRITICAL AREAS: ._. GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE: 1 0 B i- COVERED DECK:
FRONT SETBACK: 30 0- CURRENT PROPERTY USE: s- t; c -.o_,.\ DECK:
REAR SETBACK: \ CJ k V CURRENT SEPTIC USE:1-�4---
LEFT SETBACK: 42ii4. °et' CURRENT WELL USE:-------
RIGHT SETBACK: T F \- IMPERVIOUS SURFACE AREA:
1
7 MANUFACTURED HOME SIGN
1
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
FIRE ALARM:
TENT:
BLASTING: DATE/TIME:
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
i
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 °CONCRETE ® REINFORCEMENT
FIRM NAME:
INSPECTOR(S):
PHONE:
WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO
IS PUBLIC WATER AVAILABLE: 0 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#; EXP/RES: V/NAE
AUTHOR/ZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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PLANNING DEPT. APPROCcD
BY: 124 Clita
DATE: