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2003, 10-15 Permit App: BLD-03-02781 Pole BldgPERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUNITY DEVELOPMENT BU/LD/NG DIVISION 9 9707 East Sprague Ave Ste 106 Spokane Valley, WA 99206 Phone: (509)688-0036 Fax: (509)688-0037 REQUIRED SITE INFORMATION STREET ADDRESS: 703 L/ (;C-12. C_ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: PERMIT DESCRIPTION: "f)(\ *MIMING PERMIT CI -RELOCATION • 10CHANGE IN -USE .D.GRADING .0—MANUFACTURED HOME Q SIGN Q TENANT ]-OTHER OWNER / APPLICANT INFORMATION ° OWNER: bJ2J U Mprycj 19t -APPLICANT: PHONE:66g Ci Zi -CP( FAX: C%Z/ _ 3 2.S- PHONE: FAX: ADDRESS: ; 7 os 67 PLS. }aL LLA 20S ADDRESS: ,STATE, ZIP CITY, STATE, ZIP ® ARCHITECT: El CONTRACTOR: PHONE: FAX: PHONE: ADDRESS: ADDRESS: CITY,. STATE, ZIP FAX: WA ST CONTRACTOR LICENSE # CITY, STATE, ZIP CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT: BUILDING HEIGHT TO PEAK: BUILDING DIMENSIONS: NUMBER OF STORIES: NUMBER of BEDROOMS: FLANKING SETBACK: SS r FRONT SETBACK: 5, REAR SETBACK: 5 LEFT SETBACK: 30% SLOPES ON PROPERTY: 'CI— OCCUPANCY GROUP: CONSTRUCTION TYPE: fe L 2_ STRUCTURES ON PROPERTY: CRITICAL AREAS: CURRENT PROPERTY SIZE: CURRENT PROPERTY USE: CURRENT SEPTIC USE: CURRENT WELL USE: RIGHT SETBACK: 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: i RELOCATION PREVIOUS ADDRESS: SQ FT OF SIGN: # OF SIGNS: AREA OF EXIST SIGN: TYPE OF SIGN: HEIGHT OF SIGN: PROPOSED USE: FIRE SPRINKLER: FIRE SAFETY FIRE ALARM: PAINT BOOTH: TENT: FIREWORKS DISPLAY: 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 O BOLTING ®CONCRETE 0 REINFORCEMENT FIRM NAME: INSPECTOR(S): PHONE: 0 WELDING FAX: BUILDING STAFF USE ONLY 1 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 IF YES: © COUNTY • CITY DATE: METHOD OF PAYMENT: O 0 CASH CHECK 1 STAFF: BANKCARD #; EXPIRES: VIN # AUTHOR/ZED SIGNATURE* *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD jPt APPROVED BY, Palk r 41;4 Qthegr' Lque ;