2003, 11-03 Permit App: BLD-03-02966 RemodelPERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITYDEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206....
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
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STREET ADDRESS:
S i7/ -
/ 4 d1/ /.74��
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
• PERMIT DESCRIPTION:
a BUILDING PERMIT • aCHANGE IN USE
-RELOCATION
®-SIGN
GRADING O.MANUFACTURED HOME
®-TENANT EtOFtIELR
OWNER / APPLICANT INFORMATION
® OWNER:
y
PHONE: C/26 - FAX:
ADDRESS: V/- S Y�1�/e lC
CITY,STATE, ZIP
CONTRACTOR:
® APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
PHONE: J 4-ih FAX:
ADDRESS: l f
CITY,. STATE, ZIP
WA ST CONTRACTOR LICENSE #
ARCHITECT:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: !, 00(,
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
"NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
OCCUPANCY GROUP: 2ND FLOOR SQ FT:
CONSTRUCTION TYPE: UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
COVERED DECK:
DECK:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OIJ SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
TENT:
DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:.
PHONE: FAX:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
Cl BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME:
PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES C 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: Ei YES NO PSSA: Q YES 0 NO
DATE: '
METHOD OF PAYMENT:
® p
CASH CHECK
STAFF:
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD