2003, 10-28 Permit App: BLD-03-02923 ReroofcfF
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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: 20 Cr 5
ASSESSOR'S TAX PARCEL NUMBER:
LEGAL DISCRIPTION: 19 cm. Q
PERMIT DESCRIPTION: - S _� \ o2v, 1Z0
�BUILDING PERMIT 131 CHANGE IN USE • a_GRADING
0 -RELOCATION E7 -SIGN O -TENANT•
.0 -MANUFACTURED ROME
OWNER / APPLICANT INFORMATION
OWNER: S i rt La_a_1 I 4,..`�.��,1 t S
PHONE: 4-2-1
2 i L7 0'4$`l
ADDRESS: /J Z.43 S v
°CONTRACTOR:_ _
FAX:
CITY,STATE, ZIP
PHp (f7 FAX:
® APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
9,A RCHITECT.:
PHONE:
ADDRESS:'SYZIC `ksG� (�r`kL.. 99Z�`�
1CITY, S�TATE, ZIP
WA ST CONTRACTOR LICENSE # t 0 -AA - pg
FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:)% 60
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
'NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
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:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:.
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
MANUFACTURED HOME SIGN
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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:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
®CONCRETE
® REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® COUNTY 0 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: 0 YES 0 NO PSSA: 0 YES 0 NO
DATE:
7
METHOD OF PAYMENT:
0 O
STAFF:
CASH CHECK
BANKCARDEXP/RES:VIN#
AUTHOR/ZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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