2003, 10-24 Permit App: BLD-03-02881 Enclose Porch cm ogrisiiit
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIV/S/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
1 Phone:(509)688-0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: ! yJ /0g, Y�a
ASSESSOR'S TAX PARCEL�/ NUMBER(S): 4 r1 Aix/ , t 5 2 7
LEGAL® DISCRIPTION: /57R,4 1� .dcif ,r� df 4./ ,4 4/
�;ie' __42 , �T Co -- -ecCdI✓,
PERMIT DESCRIPTION: -)c _... ,n .�i p C'/ )_5E= t'v/ �-� mz
0 BUILDING PERMIT CI CHANGE IN USE 0 GRADING l MANIJ+ACTt HOME
®RELOCATION Q SIGN °TENANT DOTTIER
OWNER / APPLICANT INFORMATION
%OWNER: e9 /ti S1 8 F- AV6 s S 0 APPLICANT:
PHONE:SQ 9-/%/—it O / FAX: PHONE: FAX:
ADDRESS: 1 5 f/ 1 £ Vd/4'.vITMleapTTE,ZIP ADDRESS: CITY,STATE,ZIP
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CONTRACTOR: 99&37
ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION t
1
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: /A Vd
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: 3,V.,-- CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
HMANUFACTURED HOME SIGN 1
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
I RELOCATION FIRE SAFETY
1
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE 1
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
1 SPECIAL INSPECTIONS I
a BOLTING ®CONCRETE a REINFORCEMENT a WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
I BUILDING STAFF USE ONLY
1
IS PUBLIC SEWER AVAILABLE: a YES a NO IF YES: a COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: a
YES a NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES a NO PSSA: 0 YES 0 NO
IDATE: ' STAFF: '
METHOD OF PAYMENT::
CASH CHECK LM yISA� __� a"
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
1
10/24/2003 11:02 5093241567 SRHD EHS PAGE 01
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SPOKANE COUNTY HEALTH DISTRICT
ENVIRONMENTAL HEALTH DIVISION APPL.l1
FINAL INSPECTION FOR SEWAGE SYSTEM AT )5-4 E. 1/4119
(numerical address or lot and block in plaor section, tow)ship, and range and road)
Please fill out in heavy dark line (felt-tip pen or equal) with a straight edge. Plan
is to include outline of structure (if available) as' its position occurs on the prop-
erty. Identify by measurement actual location of septic tank, drainfield lines,
drywell, or other on-site sewage facilities, property lines closest to drainfield,
on-site well '(when applicable), driveway, and road frontage. Septic tank access
must be referenced to a known fixed surface structure.
NORTH
pC i X X X
A,�eido R.
27.121
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65 19 1
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:)C 10,4 c:r iM! OLv.SitE 5E14.664_1'
5r57EM REPRESF.NTM SY THE DRAWMC
IS NOT TO BE CONSTRUED AS AN
EXACT LOCATION Of Ttif SYSTEM, ff
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FINAL INSPECTION MADE BY 1/- P,-
COMMENTS: (I ,:''`feTOR'S NAN ) I (DATE)
1/83
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OCT 21 2003 11:05
5093241567 PAGE.01
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