2003, 09-11 Permit App: BLD-03-02437 Basement crrr
do•VValley
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
STREET ADDRESS: /9a ) La E k,y3rt.xL A/
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
a]BUILDING PERMIT a CHANGE IN USE D GRADING I]MANUFACTURED HOME
Q RELOCATION E SIGN Q TENANT 0 OTHER
OWNER / APPLICANT INFORMATION
® OWNER: C Le JaNi C si.- � fr(S ® APPLICANT:
PHONE: Q ,' i 7 S-0 FAX: PHONE: FAX:
ADDRESS: ll� �� E.iWc). Ic wq, ”Ci Li ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: ® ARCHITECT.:
PHONE: FAX: PHONE: FAX:
ADDRESS: 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: OCCUPANCY GROUP: 2ND FLOOR SQ FT: n t
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENTv2I '�I
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT: 1-[(11
11
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:
•
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:
RELOCATION FIRE SAFETY
i
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
1
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS I
® BOLTING ®CONCRETE ® REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
L _ _A _ _._ ,____-
BUILDING STAFF USE ONLY I
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: ® YES 0 NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO PSSA: 0 YES CI NO
DATE: I STAFF:
I
METHOD OFPAYMENT:•_
0 0 O r 0
:,
CASH CHECK , . 111111111111111111111
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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