2003, 08-14 Permit App: BLD-03-02233 Shop cnoF
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4000Valley .
PERMIT APPLICATIONW ORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIV/S/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
1 REQUIRED SITE INFORMATION
STREET ADDRESS: I iV I/ 1 6( C11 Q(S. 11v tui
Ida
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISC RIPTION:
PER IT DESCRIPTION:
UILD1NG PERMIT D CHANGE IN USE D GRADING a MANUFACTURED HOME
C RELOCATION 0 SIGN Q TENANT E -O lItER
OWNER / APPLICANT INFORMATION
® OWNER: ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
i CITY TATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: / ree ® ARCHITECT.: Aje'i beK'�.
PHONE... 2 . FAX:2 /9/4; /( PHONE: % -a/o I`' FAX: //
ADDRESS: it. - A i LI. ..Q ✓! _ A., //. ADDRESS: /3 C�i (tit"��l�
is//c r og /� e. *i CITY ESTATE, j Li CI
TY,STATE,ZIP
rJjW(A(JST CON RACTt7'R LLIIC(ENSE !�///� AeeK// gitl vro ACT 0 r
PERMIT/BUILDING INFORMATION
COST OF PROJECT:iIf A 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: qa-11
BUILDING HEIGHT TO PEAK: 2 OCCUPANCY GROUP:_ V®S - 2ND FLOOR SQ FT:
BUILDING DIMENSIONS? Pb 5 l
CONSTRUCTION TYPE: UNFIN BASEMENT:
..--_
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: L FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: ' GARAGE: )/6""
FLANKING SETBACK: ' CURRENT PROPERTY SIZE:/20110COVERED DECK:
FRONT SETBACK: )9---C CURRENT PROPERTY USE: IC�e DECK:
REAR SETBACK: cCURRENT SEPTIC USE: 1
LEFT SETBACK: e c CURRENT WELL USE: As / to
RIGHT SETBACK: C IMPERVIOUS SURFACE AREA: '`
IMANUFACTURED HOME SIGN I
WIDTH: SQ FT OF SIGN: H GHT OF SIGN:
r
YEAR: WENGN______
T S #OF SIGNS: f EXIST SIGN:
w
MANUFACTURER: ‘. TYPE OF SIGN:
I RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TEN
PROPOSED USE: FIREWORKS DI7 LA :
BLASTING: DATE/TIME:
WA STATE NON—RESIDENTIAL ENERGY CODE
PLANS EXAMINER: HONE: FAX:
ADDRESS:
INSPECTOR: AclrY,STATE,ZIP
INSPECTOR: ' ONS: FAX:
ADDRESS:
CITY,STATE,ZIP
I
SPECIAL INSPECTIONS
0 BOLTING ®CONCRETE 0 REI FORCEMENT ® WELDING
FIRM NAME: '� PH FAX:
_ r
INSPECTOR(S):
BUILDING STAFF USE ONLY I
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO IF YES: ® COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: 0 YES ® 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: ® YES ® NO PSSA: 0 YES 0 NO
IDATE: I STAFF: '
METHOD OF PAYMENT:
® 0 O r 0immen
v
ISA
CASH CHECK rmo
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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