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2004, 09-30 Permit App: BLD-04-07817 Re-Roof glivokal<e\al*' 14 4.00Valley 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 I REQUIRED SITE INFORMATION I STREET ADDRESS: /7/2/./L/ ✓' o6,-✓ "/')? c -,i ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: PERMIT DESCRIPTION: re 'MO. ' UILDING PERMIT D CHANGE IN USE CI GRADING •O MANUFACTURED HOME a RELOCATION ®-SIGN 13 TENANT EtOT'IhER OWNER / APPLICANT INFORMATION . [ OWNER: 5A V t C 0"* '7 ® APPLICANT: t?( PHONE: 163©- 6 PD FAX: PHONE: FAX: ADDRESS:)7Li LI ,`CNer I CIA 4 �j'Atli gg0R66 ADDRESS: CISTATE,ZIP CITY,STATE,ZIP D CONTRACTOR: ® ARCHITECT: PHONE: FAX: PHONE: FAX: ADDRESS: ADDRESS: CITY,.STATE,ZIP CITY,STATE,ZIP WA ST eUNTRATCTOR-LTCENSE# CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT: .3wte 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: 4�O© BUILDING HEIGHT TO PEAK: /3 OCCUPANCY GROUP: 2ND FLOOR SQ FT: BUILDING DIMENSIONS: CONSTRUCTION TYPE:1S?>ti1c s 6 UNFIN BASEMENT: \,Ua NUMBER OF STORIES: I STRUCTURES ON PROPERTY: FINISHED BASEMENT: NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE: FLANKING SETBACK: CURRENT PROPERTY SIZE: ,76 COVERED DECK: FRONT SETBACK: CURRENT PROPERTY USE: DECK: REAR SETBACK: CURRENT SEPTIC USE: LEFT SETBACK: CURRENT WELL USE: RIGHT SETBACK: IMPERVIOUS SURFACE AREA: t MANUFACTURED HOME SIGN WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN: YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN: MANUFACTURER: TYPE OF SIGN: IRELOCATION FIRE SAFETY PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM: PAINT BOOTH: TENT: PROPOSED USE: FIREWORKS DISPLAY: BLASTING: DATE/TIME: IWA STATE NON-RESIDENTIAL ENERGY CODE PLANS EXAMINER: PHONE: FAX: ADDRESS: CITY,STATE,ZIP INSPECTOR: PHONE: FAX: ADDRESS: ----- ------- CITY,STATE,ZIP SPECIAL INSPECTIONS ° BOLTING °CONCRETE ° REINFORCEMENT WELDING FIRM NAME: PHONE: FAX: INSPECTOR(S): BUILDING STAFF USE ONLY 1 IS PUBLIC SEWER AVAILABLE: YES NO IF YES: ° COUNTY ° CITY IS PUBLIC WATER AVAILABLE: YES 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: ° YES ° NO PSSA: E YES Q NO • IDATE: I STAFF: METHOD OF PAYMENT: ° .�... ® ® VISTA CASH CHECK BANKCARDS; EXPIRES: WN# AUTHORIZED SIGNATURE: *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD