2003, 07-17 Permit App: BLD-03-02051 Garage R
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Milky PERMIT APPLICATIONW ORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:1509)688--0037
IREQUIRED SITE INFORMATION
STREET ADDRESS: t r)03 3 (\A• ()fl.\„vQ(S l
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: Sh bp cocp" r:vc. e
)1/BUILDING PERMIT CI CHANGE IN USE CI GRADING CI MANUFACTURED HOME
El-RELOCATION D SIGN 0 TENANT D OTLIER
- ) iOWNER / APPLICANT INFORMATION
® OWNER: 71t -«-SO.- ` JoTSm ® APPLICANT:
PHONE: ciai �l- -2 7 C FAX: C,,, PHONE: FAX:
ADDRESS: 1003 l On%ve.N 51 vk yA , ADDRESS:
fi- C ,STATE,ZIP CITY,STATE,ZIP
®CONTRA'CTOR:, ` UV ® ARCHITECT:
PHO :qQ r •• 03 all l X: PHONE: FAX:
ADDR S: ADDRESS:.
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
IMANUFACTURED HOMESIGN I
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: 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 I
0 BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: 0 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: ® 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 ® NO PSSA: 0 YES ® NO
IDATE: 1 STAFF:
METHOD OF PAYMENT:
CASH CHECK L_ - 11111111•1111111
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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