2004, 09-22 Permit App: BLD-04-07727 Remodel *lane 1 ,
Valley
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:J50S)688-0037
REQUIRED SITE INFORMATION - .
STREET ADDRESS: - 6 0`1 gaz 1J_v
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: -
ja BUILDING PERMIT 0 CHANGE IN USE a GRADING I]MANUFACTURED HOME
RELOCATION Q SIGN E TENANT -OTllER
OWNER / APPLICANT INFORMATION
® OWNER: / j 45-0- (i -�— ® APPLICANT: ' , • Ci
PHONE: FAX: PHONE:I> 3 V c)----7 (/ - FAX: <e z 6 _9
U`
ADDRESS: ADDRESS: 0 I 13070 / '7 d—/ —62)1:1--
® CITY,STATE,ZIP S„1.�J I� %T,ZIP
CONTRACTOR: C-u���e�-C _4_c- ARCHITECT: '4
PHONE: 3D c:%--7y FAX: g2D cS-59 PHONE: � FAX:
ADDRESS: ADDRESS:
CITY,.STATE,ZIP (�� CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT: /x-zL
PERMIT/BUILDING INFORMATION I
COST OF PROJECT: 6, 9vc7 / 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: ti OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: /.-- /`J---CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: 0 N`e- STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: 9/ CRITICAL AREAS: GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
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:
I
1 WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
a BOLTING 13 CONCRETE a REINFORCEMENT a WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
IBUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: a YES 0 NO PSSA: 0 YES 0 NO
fDATE: ' STAFF:
METHOD OF PAYMENT:
0 0 ® rT 0 ....•
ase ycni i WSA
CASH CHECK a iumom
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD