2003, 07-21 Permit App: BD-03-820 MHe
;*sulky PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITYDEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 906
Spokane Valley, WA 99206
Phone: =688-0036 Fax. -509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: Zx'�
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRI
PERMIT DESCRIPTION:
C1 BumDiNG PERMIT
13RELOCATION
Lv r d'±'-
13 CHANGE IN USE E7 GRADING ,bI4 N ACTURED HOME
O SIGN j TENANT ®-OTHER
OWNER / APPLICANT INFORMATION
® OWNER:*t.
S�j-!1J i 1412 ft4 -
509 ?/e)" 0,39-30 FAX:
PHONE: Zs1j
ADDREssfe �7a /G 4' "C K 2- >2
`7 P,0&:n0,Nt 0„a r,�►Q�ZCITY,STATE, ZIP
® CONTRACTOR:
PHONE: FAX:
ADDRESS:
CITY,.STATE, ZIP
WA ST CONTRACTOR LICENSE
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
® APPLICANT:.
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
® ARCHITECT.:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SO FT:
2ND FLOOR SO FT
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
MANUFACTURED HOME SIGN
WIDTH:_ LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR:2 PIT SET: # OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER:5tVL I A) L TYPE OF SIGN:
RELOCATION
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SAFETY
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
®CONCRETE ® REINFORCEMENT
PHON
BUILDING STAFF USE ONLY
CITY, STATE, ZIP
® WELDING
FAX:
IS PUBLIC SEWER AVAILABLE: 0 YES 13 NO IF YES: 13COUNTY E3 CITY
IS PUBLIC WATER AVAILABLE: a YES a NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 13YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES 13 NO PSSA: Q YES [3 NO
DATE: STAFF:
METHOD OFPAYMENT--
0 13 13 iml
CASH CHECK
BANKCARDS; EXP/RES: V/N#
AUTHOR/ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
6 Utility •
Ease men t
••rte y ECT
F. INSURANCE COMPANY .33
m
v
I, without charge, tor your
Mended to show all matters
including, but not limited to,
ements, encroachments, or
;. It is not part of, nor does it
►nt of policy to which it is .
ny assumes NO LIABILITY for
this sketch. Reference should
ite survey for further. information.
ST , war
45.62
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FINAL AS -BUILT INSTALLATION
Address/Legal Description: /3Z 5, & 9I52O3.6)/-)od
Subdivision/Block/Lot: jYL,4,& L� Pin
Application
THE LOCATION OF THE ON-SITE SEWAGI
Remarks: SYSTEM REPRFSENTED RY THE DRA`.NINC
IS NOT TO P,F CONSTRUED AS AN
LUCA11UN
Signature
Date",
/ �0
Septic Tank Size: gals.
Drainfield: ft.
Leachbed: ft.
uble Plumbing ❑Yes jIINo
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