2003, 09-05 Permit App: BLD-03-02403 GarageC2- L[Q3
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
9309 E c;11\i,
ASSESSOR'S TAX PARCEL NUMBER(S): 3 fi `, 1 f 5 1 b
LEGAL DISCRIPTION: L 1 'P i 'N
IN —rye pc'"'4O F 5eukRPC
PERMIT DESCRIPTION:
(LOc fPFj2 I? p .- non r-ii o/v
mop 3 3 L k 1 t' f't(TS ('45r_ 3
EiDUELDING PERMIT 0 CHANGE IN USE 0 GRADING
DRELOCATION
C} SIGN D TENANT
MANUFACTURED HOME
°OTHER
OWNER / APPLICANT INFORMATION
OWNER: in b
PHONE: 50 `1, - 5)11,0 6,1
73
ADDRESS:
® APPLICANT:
FAX: , /t, PHONE: FAX:
S` 7-0 f (11/4 ( ¶12I2ADDRESS:
CITY,STATE, ZIP
CONTRACTOR:
PHONE:
ADDRESS:
CITY,. STATE, ZIP
FAX:
® ARCHITECT:
PHONE:
ADDRESS:
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK: 15 r
BUILDING DIMENSIONS: 2r) X 2 (-(p
NUMBER OF STORIES: L
NUMBER of BEDROOMS: d
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
"4°I
LEFT SETBACK:
1
RIGHT SETBACK: 1 "1
See,'
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
CONCRETE
0 REINFORCEMENT
PHONE:
0 WELDING
FAX:
BUILDING STAFF USE ONLY
r
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO
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: 0 YES 0 NO PSSA: 0 YES 0 NO
IF YES: • COUNTY ▪ CITY
DATE:
STAFF:
METHOD OF PAYMENT:
O 0
CASH CHECK
BANKCARD #; EXPIRES: VIN #
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
1
3
APPROVED BY
09/05/2003 lb:lb 5by3241bb/
SEP 02 2003 15:58 FR
�Rnu c.n.
TO 3241567
SEP 02 2003 16:18
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