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2003, 07-28 Permit App: BLD-03-02089 Garage sraan.$09\.. dp# Val , 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: . 1. 4.e41 j ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: PERMIT DESCRIPTION: ►� 'MIMING PERMIT EI CHANGE IN USE CI GRADING 0 MANUFACTURED HOME Q' LOCATION Q SIGN laTENANT Et OTHER I OWNER / APPLICANT INFORMATION 1 f- A 0 OWNER: .07 S g. e�J' 0 E 5 11 10 .501) ® APPLICANT: PHONE: S�' ' /7?' )?9Y© FAX: pet PHONE: fAX: ADDRESS: gib/V ( C4J Mal(tgr. /act- 9gi2O v ADDRESS: CITY,STATE,ZIP - CITY,STATE,ZIP ®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: 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: (ax0i c'^I 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 71`, WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN: YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN: MANUFACTURER: TYPE OF SIGN: IRELOCATION FIRE SAFETY PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM: PAINT BOOTH: TENT: PROPOSED USE: FIREWORKS DISPLAY: BLASTING: DATE/TIME: IWA STATE NON-RESIDENTIAL ENERGY CODE PLANS EXAMINER: PHONE: FAX: ADDRESS:. CITY,STATE,ZIP INSPECTOR: PHONE: FAX: ADDRESS: CITY,STATE,ZIP I SPECIAL INSPECTIONS ® BOLTING °CONCRETE 0 REINFORCEMENT 0 WELDING FIRM NAME: PHONE: FAX: INSPECTOR(S): BUILDING STAFF USE ONLY CI D 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 Ef NO PSSA: 0 YES 0 NO IDATE: ' STAFF: METHOD OF PAYMENT' 0 ..ism. CASH CHECK BANKCARD#; EXPIRES: VIN# AUTHORIZED SIGNATURE: *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD APtROVED BY W2,a yvt_cuLtrt....71_, .40 6.1 rfr rct rsj J"\\i" •