2003, 11-17 Permit App: 04009097 Safety Inspect *lane cq ,910? -
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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: 10 0 , (t0-1
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: ��ODS
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CI BUILDING PERNIIT
CHANGE IN USE O GRADING D MANUFACTURED HOME
CI-RELOCATION 0 SIGN 0-TENANT IHER
OWNER / APPLICANT INFORMATION
OWNER: a M I'-"�C� J 0 APPLICANT:
PHONE: CIS?) / / I }��
(,(/`'1 �V FAX: 1/ PHONE: FAX:
ADDRESS: �) , 3 01 If n --rhe ,/(� e ADDRESS:
C TI, ,EySTA '']'}[��r!P�f� CITY,STATE,ZIP
CONTRACTOR: � Q ARCHITECT:
PHONE: FAX:
PHONE: FAX:
ADDRESS:
ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 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:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN I
f
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OP SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
•
RELOCATION FIRE SAFETY
1
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
t WA STATE NON-RESIDENTIAL ENERGY CODE
1
PLANS EXAMINER: PHONE: FAX:-
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I
I SPECIAL INSPECTIONS
® BOLTING °CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES NO IF YES: 0 COUNTY 0 CITY -
IS PUBLIC WATER AVAILABLE: 0
YES 0 NO IF YES,WHICH WATER DISTIIRR:
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
I DATE: I STAFF: I
•
METHOD OF PAYMENT:
T 0
® ® I VISA
CASH CHECK
BANKCARD#: EXPIRES: VIN# _
AUTHORIZED SIGNATURE: -
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD