2004, 01-20 Permit App: BLD-04-03423 Basement CITY OF 1
Mlley
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
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. STREET ADDRESS: I rt,2,25— C f47.7 vc,-,04,1k. LA , 6rervtuc res t / Lill. C11616^
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: Cr1;S 1-1 Fc,5G'.nrk1 r 5 1d4,-��,. / & / / /2e-, m
CI RITILDING PERMIT CICHANGE IN USE a_GRADING •O MANUFACTURED HOME
}RELOCATION 0 SIGN }TENANT Of OTHER
OWNER / APPLICANT INFORMATION
1
0 OWNER: 've1 5 Ile I t*6 L 0 APPLICANT:
PHONE:(9 ) `i26l 7SS'/7 FAX: PHONE: FAX:
ADDRESS: / ,2,,7 C C. ,-very,„(K l.�c_ G,-r,cnrt„ ? ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: S e k F ® ARCHITECT:
PHONE: FAX: PHONE:
FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 0-Y)'• 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: rz
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 Or 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
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I SPECIAL INSPECTIONS
a BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
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: ® YES ® NO
IDATE: , STAFF: I
METHOD OFPAYMENT:
® a ® r
v WSA
CASH CHECK -
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD