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2004, 10-28 Permit App: BLD-04-08061 Addition1 001\4... 'Wine STREET ADDRESS: J `4 ii\ kb k_t v I f vJ qo co PERMIT APPLICATION WORK SHEET 33co „ SPOKANE VALLEY COMMUNITY DEVELOPMENT BUILDING DIVISION 11707 East Sprague Ave Ste 106 Spokane Valley, WA 99206 Phone: (509)688-0036 Fax: (Z09)688-0037 REQUIRED SITE INFORMATION 5022 N Svany VAII D. ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: PERMIT DESCRIPTION: 10' X 1$ ' / OA UII,DING PERMIT ®RELOCATION CI CHANGE IN USE C GRADING 0 MANUFACTURED HOME SIGN C TENANT D ° FILER i OWNER / APPLICANT INFORMATION OWNER: Z"--1 Iwo rye . N &it P(Z-OC1 Er PHONE: �(c �} - ZI L%(l/ FAX: ADDRESS: 5-027 N `I SJn✓► `/ UA I ) ITY,STATE, ZIP El CONTRACTOR: PHONE: FAX: ADDRESS: CITY,. STATE, ZIP WA ST CONTRACTOR LICENSE # APPLICANT: PHONE: ADDRESS: CITY, STATE, ZIP FAX: ARCHITECT: PHONE: ADDRESS: FAX: CITY, STATE, ZIP CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT: I .,�y' /SCR)ny o 30 /o SLOPES ON PROPERTY: BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT: NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT: NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE: MAIN FLOOR SQ FT: 2N0 FLOOR SQ FT: FLANKING SETBACK: FRONT SETBACK: REAR SETBACK: LEFT SETBACK: RIGHT SETBACK: 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 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 0 BOLTING FIRM NAME: INSPECTOR(S): °CONCRETE ® REINFORCEMENT PHONE: ® WELDING FAX: BUILDING STAFF USE ONLY IS PUBLIC SEWER AVAILABLE: 0 YES CI 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: ® YES 0 NO PSSA: ® YES 0 NO IF YES: 0 COUNTY ®CITY DATE: A. METHOD OF PAYMENT: 1 STAFF: 0 CASH CHECK BANKCARD #; VISA EXPIRES: VIN # AUTHOR/ZED SIGNATURE' (its_ /'. / C,,( P( *FAXED PERMIT APPLICATION ILL ONLY BE ACCEPTED WITH MAJOR BANKCARD 1 ORDER NO: PACIFIC NC)RT T TITLE Compal y- of Spolcart , Trtc_ 120 W. CATALDO, #100 SPOKANE, WASHINGTON 99201 (509 744-3434 - FAX (509) 747-6827 ■ ■ ■ ■ t ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ a ■ ■ ■ • ■ ■ ' . „I : ' 1 18° 11 90 a5 107. s4 ICS.46 ts+o.f7 rtf. !S a . • . •4 • 0 3� z ® o jN 9 0 co • 8 7 b : 8 �o111 ... ■ ■ Oty IM pIc A venue 5 .: El .. a4P is ■$3• ■ 77.• 'oz.so• Ilz.sp •-• ■ 1 a ■ • • ■ ,p% G 0 t• - 3 n t ■ ':' -t. ® 3 0 . C.) • �'- ,, ., . ., • ,•v... 6• 3 5 t , ■ 2 11 q 02• , a 1 % i2 •es . .ez ..oz• t �, = : ■ 8 • 8 Q so 2 Q1 ' 0la • i� • I:71 • ' © .. ©• gond GWGrit4t Ord4d Arc ■ ■ ■ ■.hue; 711 •//\\ �4. / I �`.-i� lc -114 • ■ . © . 4 l'! o - v ■ M q. 3 13 a 1� ..+�s .�S S ; J 3 9't■ L $4. . • ■ 1 tZ ■ ■ ■ ■ ■ ■ ti 1 ■ .•1 1 1 ■ ■ 1 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ r 1 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ik This map is furnished for information and location purposes only. Courtesy of: Pacific Northwest Title of Spokane sKETCf# aonDweror owner Jimmy N & Angela M Cameron Property Aearese 5022 N Sunnyvale Drive cm Spokane county Spokane Slate WA Code 99216 Lender «Client First Horizon Home Loans mss ZONEL ROAD WIDTH FRONT COMMENTS REVIEWED .441 Sts CiEti1260r. '`pjraisals,Inc. GI A. 06( e PP• This she plan is being submitted for the pt,hpose of obtaining a building permit and is a true and correct representation of the proposal. MI known ';property lines/dimensions..curb lines, structures and easements have been identified. Nes ind4s$sd are wetlands, bodies of r. steep or other critical areas. Page 10 of 20 Signed: aa: l0//f 0']