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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: R / tS ) V'? 1, wa'y
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
® BUILDING PERMIT
URELOCATION
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D CHANGE IN USE
0 SIGN
a GRADING
C TENANT
a MANUFACTURED HOME
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OWNER / APPLICANT INFORMATION
FA OWNER: D Cs()F,f Ej/ h 1 �,1� ® APPLICANT:
PHONE: .513 €69 2 S Z 3H FAX: r0SO PHONE: FAX:
ADDRESS: —SiMi — 5.f 29kcvvst e—, vim get 2% 0 (, ADDRESS:
CITY,STATE, ZIP CITY, STATE, ZIP
®CONTRACTOR: ® ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 3o00-91)
BUILDING HEIGHT TO PEAK: 14
BUILDING DIMENSIONS: 34/x2 l '
NUMBER OF STORIES: /
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY: JO -
OCCUPANCY GROUP:
CONSTRUCTION TYPE: S-A/
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE: X
COVERED DECK:
DECK:
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
1
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING:
DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
®CONCRETE
® REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE:
® YES C NO
IS PUBLIC WATER AVAILABLE: 0 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 ® NO
DATE:
STAFF:
METHOD OF PAYMENT:
CASH CHECK
VISA
BANKCARDS; EXPIRES: V/NAS
AUTHOR/ZED S/GNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
1
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