2003, 11-10 Permit App: BLD-03-03039 Remodel f f
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.0•0Valley
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
REQUIRED SITE INFORMATION
STREET ADDRESS: E. 16 Vonirw`� ' ye ' d a I c . 976) 3 7
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:brio/ , ti S litALS 2 iv; SC Wel- r'€Vtr5 C
O BUILDING PERMIT 0 CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
Q RELOCATION D SIGN C TENANT ®O FHER
OWNER / APPLICANT INFORMATION
® OWNER: G Yy n ,- C, , 1 L e ® APPLICANT: S 1'1
PHONE: $q 2-0 t/-/ 7 FAX: S'1 PHONE: FAX:
ADDRESS:,/ 5 X S LI//;V:, Pm b * /9 ADDRESS:
v eV-Ad C{ itAs6 ytit/03�ITY,STATE,ZIP CITY,STATE,ZIP
®
CONTRACTOR: 6.( Lf ! ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: 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 HOME r SIGN
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
1 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: ® COUNTY 0 CITY
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: 0 YES 0 NO PSSA: 0 YES 0 NO
I DATE: [ STAFF: '
I
METHOD OF PAYMENT:
0 0 0 r Y 0 min=
CASH CHECK L11111111111111111111111
SA
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE::
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD