2003, 10-02 Permit App: BLD-03-02652 Repair Fire Damage CPf1'
oveNtwok
4.0#ValleY
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: CI C E. 2..h O ,AVE.
ASSESSOR'S TAX PARCEL NUMBER(S): -6S-93g- 1Q0.g,
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: c-xge D,q,,,,yi CRE R,p. ,.
EKUILDING PERMIT D CHANGE IN USE 0 GRADING ®MANUFACTURED HOME
QRELOCATION D SIGN Q TENANT D OTHER
OWNER / APPLICANT INFORMATION j
OWNER: L-,AVbiA ?At-TAUS(?d: ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: 41 '1 C. , • A . • ADDRESS:
CI ,STATE,ZIP CITY,STATE,ZIP
CONTRACTOR: C '.C'CS-TSE L tunST e- ARCHITECT:
PHONE: SS9-626.5 FAX: ' S 1 -O(s2C) PHONE: FAX:
ADDRESS:Vb.'"? €. nv4i. . 60494..ic YA 5S72, ADDRESS:
CITY,.STATE, I57212.P CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CZFEKO.g9-12.I(h CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 55,4,x%cm, 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: Sac)
BUILDING HEIGHT TO PEAK: 152: OCCUPANCY GROUP: 3R.. 2ND FLOOR SQ FT: 1(00
BUILDING DIMENSIONS: 2.5X3(,» CONSTRUCTION TYPE: Rf-AwiE UNFIN BASEMENT: Qf
NUMBER OF STORIES: I 142- STRUCTURES ON PROPERTY: / FINISHED BASEMENT:/
NUMBER of BEDROOMS: 2_ CRITICAL AREAS: GARAGE: �f
FLANKING SETBACK: --4,/ CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: 2.5 I CURRENT PROPERTY USE: DECK: 0
REAR SETBACK: 3 O CURRENT SEPTIC USE: r
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: � IMPERVIOUS SURFACE AREA:
IMANUFACTURED HOME SIGN I
WIDTH: LENGTH: . SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
i RELOCATION _ FIRE SAFETY 1
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
0 BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
IBUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: 0 COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: 0 YES 0
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: 0 YES 0 NO PSSA: 0 YES 0 NO
IIDATE: ' STAFF:
METHOD OF PAYMENT::
0 0
_ .
® MashyCsitt VISA
CASH CHECK nommim
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE;
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD