2003, 09-05 Permit App: BLD-03-02404 Garage sornakallopiee\,..
.00Valley
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
IREQUIRED SITE INFORMATION
STREET ADDRESS: 112-f)2-f) (5 Z[,kt p,A / d/Orka-.-•-e / OA- ggMe,
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: ,q-, 6
•i BUILDING PERMIT J CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
1 ' LOCATION Q SIGN Q TENANT Ej OTHER
L OWNER / APPLICANT INFORMATION
OWNER: 4 lI net (-(4.74-.4/ ® APPLICANT:
PHONE: /Z .-270 3 FAX: �/7 PHONE: FAX:
ADDRESS: /0 2c S 0k.. Sidict A/ Val. ADDRESS:
CITY,STATE,ZIP U CITY,STATE,ZIP
®CONTRACTOR: 0 ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION f
COST OF PROJECT: 3 ` ,,,LD 7 30%SLOPES ON PROPERTY: 44 1,1-4- MAIN FLOOR SQ FT: 171/0
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: A 2ND FLOOR SQ FT: "1"'
BUILDING DIMENSIONS: �I'kw' CONSTRUCTION TYPE: Cr-444-e- UNFIN BASEMENT: Air-A4
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: Aa1 FINISHED BASEMENT: ��`
NUMBER of BEDROOMS: '4,- CRITICAL AREAS: Nel"'t-- GARAGE: Yes
FLANKING SETBACK: CURRENT PROPERTY SIZE: (IDP X MO/ COVERED DECK: ilk
FRONT SETBACK: 6/ ( CURRENT PROPERTY USE: k'e5464—c-12- DECK: fJt?
REAR SETBACK: 113' CURRENT SEPTIC USE:
LEFT SETBACK: )--)-// CURRENT WELL USE: A./,,t-1-
q
RIGHT SETBACK: G r IMPERVIOUS SURFACE AREA:
IMANUFACTURED HOME a SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
lRELOCATION FIRE SAFETY I
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
I SPECIAL INSPECTIONS
® BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 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: ® YES 0 NO
IDATE: I STAFF:
METHOD OFPAYMENT,•
® O ® r - 0 .......■
VISA
CASH CHECK - 1111111111111111111
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
._..
Li i / 70
...,.„..„..........
I
r.--- .
k .
$. .
.. { . .
, \
'...,„.. 1
i
. C., I
Ito
le t.........
, .
4,, '7—m-
-,. / 4,EX5 itlardSE'
if.' gZ? 1 CA4Aate A 44 1 r,
, .....
'''''' '
Pi_OT Pi-A I\I
..,
)80/0 S. 1.,(11-iIPPI
........ ., i .
-N
•,, „,.
i I
i .
. :. .7, ,,........-.)
, I APPROVED
. I .
. .
. .
. .6„..