2003, 11-17 Permit App: BLD-03-03084 Finish Basement crer
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--J PERMIT APPLICATIONW ORK 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 6 15 --- '`1
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ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
l BUILDING PERMIT 0 CHANGE IN USE a GRADING a MANUFACTURED HOME
Q RELOCATION Q SIGN }TENANT 0 OTHER
OWNER / APPLICANT INFORMATION
OWNER: I' ' p4 /j- ® APPLICANT:
PHONE: 15(2`3 5'27 94'7 FAX:Q PHONE: FAX:
ADDRESS: 1 7 6 (52 " �C../,,te.. 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: 4 000. 0,-230%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:7/
NUMBER of BEDROOMS: 2 CRITICAL AREAS: GARAGE:
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:
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
SPECIAL INSPECTIONS
I
® BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: 0 COUNTY 0 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 ® NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES ® NO PSSA: 0 YES 0 NO
IDATE: I STAFF: '
METHOD OF PAYMENT.
0 0 0 r 0 VISA
CASH CHECK
BANKCARD//; EXPIRES: VIN#
AUTHORIZED SIGNATURE*
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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/3-4471 BUILDING DIMON
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