2003, 12-11 Permit App: BLD-03-03242 Pole Bldg Addtion arvor 101011e1\1111%
.0•••vValley
PERMIT APPLICATIONW ORK 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
STREET ADDRESS:5 /3�..- 2
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 1 x LI ( AC/L4 _ tL(dc .
11-DUILDING PERMIT C CHANGE IN USE ]GRADING I MANUFACTUD HOME
Q RELOCATION C SIGN }TENANT D OTHER
OWNER / APPLICANT INFORMATION
® OWNER: 5' -re-A-e ® APPLICANT:
PHONE: g2 3/LI/ FAX: PHONE: FAX:
ADDRESS:. /3/.2 /57,4-4x, Z ADDRESS:
// CITY,STATE,ZIP CITY,STATE,ZIP
°CONTRACTOR: ( ' $ 37 L ARCHITECT:
PHONE: 2Z- cr 91 7, FAX: PHONE: FAX:
ADDRESS: e / // ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: A 14
OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: X l CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: C STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: 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:
IMANUFACTURED HOME _ SIGN I
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
I RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
_
I SPECIAL INSPECTIONS -
® BOLTING °CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
1
- _ BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY 0 CITY
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: ® YES ® NO PSSA: 0 YES 0 NO
IDATE: STAFF:
METHOD OF PAYMENT:
�- �■
nsasr+ rt7 a 0 WSA
CASH CHECK �■�
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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