2004, 06-01 Permit App: BLD-04-04473 Garage40,0Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: CRi' ac S , R
ASSESSOR'S TAX PARCEL NUMBER(S): 1 6O� l 1 d O CIO
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: (X It
SI o
t[BUILDING PERMIT 0 CHANGE IN USE 0 GRADING
RELOCATION
Q SIGN
0 TENANT
a MANUFACTURED HOME
0 OTHER
OWNER / APPLICANT INFORMATION
RI OWNER: G Sfcx K I op-<,i),Ste n ® APPLICANT:
PHONE: (S OCi)(4-( FAX: N A PHONE: FAX:
ADDRESS: -);aa 5, (A dtbil S ck4ne wAqi?06 ADDRESS:
CITY, STATE, ZIP
CITY,STATE, ZIP
°CONTRACTOR: S e l P ® ARCHITECT:
PHONE: FAX: PHONE:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK: i5 jl ('
BUILDING DIMENSIONS:36 u%X I't,
NUMBER OF STORIES:
NUMBER of BEDROOMS: 0
FLANKING SETBACK:
FRONT SETBACK: O
r
REAR SETBACK: /
q c AJ I O
LEFT SETBACK: Min 9L
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
OCCUPANCY GROUP: 2ND FLOOR SQ FT:
CONSTRUCTION TYPE: UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
t
RIGHT SETBACK: /h, t /1) 10 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:
PAINT BOOTH:
FIREWORKS DISPLAY:
FIRE ALARM:
TENT:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
® CONCRETE
® REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
1
IS PUBLIC SEWER AVAILABLE: CI YES EI NO
0
IS PUBLIC WATER AVAILABLE: YES NO
IF YES: ® COUNTY ▪ CITY
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 ® NO PSSA: 0 YES 0 NO
DATE:
STAFF:
METHOD OF PAYMENT:
O 0
CASH CHECK
VISA
BANKCARD #; EXPIRES: VIN #
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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