2003, 08-21 Permit App: BLD-03-02297 Finish Basement Sfaandrife\1111%, . 777 S--- C'CA_L k Lc Li; , (
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4,,,,Valley PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
t)-9111
BUILDING DIV/S/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: LA/ /7 C
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
BALDING PERMIT 0 CHANGE IN USE J GRADING Q MANUFACTURED HOME
RELOCATION Q SIGN Q TENANT E O t'HER
OWNER / APPLICANT INFORMATION , i
/OWNER: C-501 t,'tl 9` it '
K 0 , �'1,e( ( ® APPLICANT:
PHONE:(9/6J e� te. PHONE: FAXADDRESS: Q Jl/ ` j /6
C ADDRESS:
/�r� �jCI ,STATE,ZIP� CITY,STATE,ZIP
°CONTRACTOR: Y C 1 0 Ce C ,, i:4:1„, RC ITECT:
PHONE: 02I CJ .754 £6AX: �-- kri4 - NE: FAX:
V -I
ADDRESS: ts26.23 "' a ...--2, . !I°,DDRESS:
Apep/1,0 °4i
/s�CITY,.STATE, P .„y pse r}, CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# pts L/'/V °4 '7V if-(CONTACT:
IPERMIT/BUILDING INFORMATION II
COST OF PROJECT(12IOOQ , 00 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:
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE: 1,0
LEFT
LEFT SETBACK: CURRENT WELL USE: `J `
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: t
I MANUFACTURED 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:
RELOCATION FIRE SAFETY
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
I
® BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
I
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 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 0 YES ® NO
fDATE: ' STAFF:
METHOD OF PAYMENT.
0 0 0 r — i 0 ..I..■
,maws-0,,,, VISA
CASH CHECK isom.i
BANKCARD#; EXPIRES; VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD