2003, 09-03 Permit App: BLD-03-02365 Residence CffYOF
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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: /1 CO 2 E 32o LA")Zr
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
Lot' fs gLocK Z Leabutrw AA
PERMIT DESCRIPTION: SF NE--w Co"3sTit uCT;a�J •
IIIQ.DING PERMIT a CHANGE IN USE •D GRADDIG •a MANUFACTURED_HOME
QRELOCATION 0-SIGN 0-TENANT 0-OTHER
OWNER / APPLICANT INFORMATION
DOWNER: 4..Y DE N kl°' APPLICANT:
PHONE: Sot 3-70-oqS Z FAX: Soy 2G-7-5912 PHONE: FAX:
ADDRESS: 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:
f PERMIT/BUILDING INFORMATION
COST OF PROJECT: $ `/O•°°° 30%SLOPES ON PROPERTY: — MAIN FLOOR SQ FT: °3 7--
BUILD IN G
BUILDING HEIGHT TO PEAK: 28 OCCUPANCY GROUP:. '.( 2ND FLOOR SQ FT: —
BUILDING DIMENSIONS: za134. CONSTRUCTION TYPE: s" le ••-'-'I UNFIN BASEMENT:
'NUMBER OF STORIES: I STRUCTURES ON PROPERTY: a v FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE: Nev
FLANKING SETBACK: CURRENT PROPERTY SIZE: 44'3.fi5 COVERED DECK: a
FRONT SETBACK: zoo CURRENT PROPERTY USE: l-� DECK:
REAR SETBACK: `Ii CURRENT SEPTIC USE:
LEFT SETBACK: e CURRENT WELL USE:
RIGHT SETBACK: /I IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME � SIGN
•
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
0 BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY 1
IS PUBLIC SEWER AVAILABLE: a YES ® NO IF YES: ®COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: ® 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 ° NO PSSA: ® YES 0 NO
I
DATE: I STAFF:
METHOD OF PAYMENT: '
•
0 0 0 -- I ' • This document originally contained
" 1 VISA confidential credit card information which
CASH CHECK GOPv . i o was redacted pursuant to RCW 19.255.010
V / and the original document destroyed
BANKCARDS;_ pursuant to SOMI DAN G52014-030.
AUTHORIZED SIGNATURE: CW:>0 ,
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
APPROVED BY -& 9/5/a3
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