2003, 10-08 Permit App: BLD-03-02719 PoolSe`i'�l,
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVIS/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206 ..
Phone: (609)688-0038 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
0/y S, SDh nYa
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: S- r d
A+ yi
®BUILDING PERMIT CI -CHANGE IN USE •D GRADING
CIRELOCATION }SIGN fj-TENANT
PooI
.D MANUFACTURED HOME
QG.f'R ..
1
OWNER / APPLICANT INFORMATION
1
Ci OWNER:
�c01- 1-eH Aava
APPLICANT:
PHONE: 922 i, 3 0 FAX:// (r19p7
.0 PHONE: FAX:
ADDRESS:O�Y 5, -5-0,/ 0eA S he v/E /Y/t ADDRESS:
1' CITY,STATE,CIP
CONTRACTOR: �
'l/ � l CA/�'�e ka„ ,hc_ .
PHONE: -3,28--l50i `7 FAX: 5^1/772- PHONE: FAX:
ADDRESS: 6/7 6' fla/Dt ,..5;60k i ` PlOY .ADDRESS:
/� CITY,. ATE, ZIP CITY, STATE, ZIP
WA ST CONTRACTOR UCENSE # /4/6441C-1%-: 0 P( D / CONTACT:
CITY, STATE, ZIP
ARCHITECT:
* r , -
:z.TLK
PERMIT/BUILDING INFORMATION
COST OF PROJECT: Z3 OOc,
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:
30% SLOPES ON PROPERTY:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
MAIN FLOOR SO FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
1
1
1
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:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
O BOLTING
FIRM NAME:
INSPECTOR(S):
°CONCRETE
.0 REINFORCEMENT
PHONE:
WELDING
FAX:
1
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO IF YES, WHICH WATER DIST/IRR:
IF YES: 0 COUNTY ▪ CITY
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES D NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO PSSA: 0 YES 0 NO
DATE: 1 STAFF:
METHOD OF PAYMENT.'
O O 0
CASH CHECK
BANKCARD 0; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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APPROVED BY
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Scdt lehRAY
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2 o/ i S. .Son Ora
S kine V //ey, VA 9903
Sonora