2003, 07-25 Permit App: BD-03-859 Residence•/\.,
.00Valley
it 02 -�55
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: / 7 / RC///4
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
THI6 BUILDING SUBJECT
TO F� I Q INISPEQTION AECTIONS
/a'J � l Obi /,�,e G4/ fI
ONS
WDUTLDING PERMIT 0 CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
['RELOCATION
0 SIGN Q TENANT
E OTHER
1
OWNER / APPLICANT INFORMATION
OWNER: %00
® APPLICANT:
PHONEc} .5 e'S1'1 X:-5 `5T -G -ii PHONE:
ADDRESS: 673 e%L(' 4VE, 4 DRESS:
CITY, STATE, ZIP
FAX:
°CONTRACTOR:
PHONE:
ADDRESS:
CITY, STATE, ZIP
CITY,STE, ZIP
FAX:
WA ST CONTRACTOR LICENSE #
ARCHITECT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
Df)
COST OF PROJECT: / '° U
BUILDING HEIGHT TO PEAK: / `f
30% SLOPES ON PROPERTY: /
OCCUPANCY GROUP: /
MAIN FLOOR SQ FT: /45-C)
2N0 FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: f 4477, UNFIN BASEMENT: )/Z5
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE: a K).35 COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE:l.! S DECK:
REAR SETBACK: CURRENT SEPTIC USE: S& -AZ.
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
r
P pt I c�. I�iIG�JdUF�I GIFT
:-1/101-1 OD 1401TD3 I4I CQJ31; O I
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
TENT:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
°CONCRETE
® REINFORCEMENT ® WELDING
PHONE:
FAX:
1
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO
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: ® YES ® NO
IF YES: ® COUNTY ® CITY
PSSA: 0 YES 0 NO
DATE:
1
STAFF:
METHOD OF PAYMENT.:
0 0
CASH CHECK
VISA
BANKCARD #; EXPIRES: VIN #
AUTHORIZED SIGNATURE.'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
1