2004, 11-19 Permit App: BLD-04-08142 Tear Off, Reroof sornokane0"lifti,
ValleY
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206. ..
Phone:L509)688-0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION -
STREET ADDRESS: /6:: 7's 6-71s1 VA-‘47['Of}
ASSESSOR'S TAX PARCEL NUMBER(S): f�Sj 4 05),42
LEGAL DISCRIPTION: V�`'Y�'/� 4'0 2 �, � ZIP
PERMIT DESCRIPTION: 44-,.".e._ -T-`, , 1'
ji6UILDING PERMIT . 13 CHANGE IIN USE • 0 GRADING I:1 MANUFACTURED HOME
f RELOCATION -SIGN 0-TENANT 0-OTHER
OWNER / APPLICANT INFORMATION
OWNER: L 6 N,,s
y / APPLICANT:
PHONE:53>-92-7-1/4-.2--(--FAX:/ PHONE: FAX:
ADDRESS:A 7L 6. V4CCeyWy y/A5.,11 64-4 %c/03 7 ADDRESS:
P 1 CITY,STATE,ZIP CITY,STATE,ZIP
13 13
CONTRACTOR: ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: I ` 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: '`°i OCCUPANCY GROUP: 2ND FLOOR SQ FT:.
BUILDING DIMENSIONS: Ze ,c 3,0 CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: ' FINISHED BASEMENT:
NUMBER of BEDROOMS: 2— 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 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:
1 WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
•
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
l SPECIAL INSPECTIONS
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES NO IF YES: ® COUNTY ® CITY -
IS PUBLIC WATER AVAILABLE: ® YES ® 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 ® NO . PSSA: 0 YES 0 NO •
IDATE: I STAFF: '
METHOD OF PAYMENT:
:frbst,iorli VISA
CASH CHECK i_ j_ mwmmo'
BANKCARDS; EXPIRES. VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD