2003, 07-01 Permit: BD-03-779 ReroofSlit ri-el
jValley
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LSD o3-77%
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
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STREET ADDRESS: I`S k S— GJ Z-
5el, u,o w4-- Cam /k,
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
♦L'] I3iJILDING PERMIT
E]RELOCATION
D CHANGE IN USE • D GRADING
E} SIGN
CI -TENANT
D MANUFACTURED HOME
E}OYHER
1
OWNER / APPLICANT INFORMATION
D OWNER: t)
D APPLICANT:
PHONE: CI; G '' (S i-- FAX: It, hit Wt`PHONE:
ADDRESS: I3`, I ' X. 5 2�J'- Sionh4[40 9 D4\DDRESS:
Pati-
CI1W,STATE, ZIP CITY, STATE, ZIP
DCONTRACTOR: D _I. r ` _ t D ARCHITECT:
PHONE: FAX:
FAX:
PHONE: Ra45-33'c\ FAX: fl --3& '
r \7
ADDRESS:PO L%». Ic{).'l63 AGOLKSL LM- 1Qa`'+ ADDRESS:
/ CITY,. STATE, ZIP CITY, STATE, ZIP
WAST CONTRACTOR LICENSE # ?sl -Y -.Jt( 4si-83
CONTACT:
1
PERMIT/BUILDING INFORMATION
COST OF PROJECT` Q:700 30% SLOPES ON PROPERTY:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
'NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
OCCUPANCY GROUP:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
CONSTRUCTION TYPE: UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
AL1' �O
MANUFACTURED HOME SIGN
WIDTH:
YEAR:
MANUFACTURER:
LENGTH:
PIT SET:
SQ FT OF SIGN: HEIGHT OFSIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
FIRE ALARM:
TENT:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
1 SPECIAL INSPECTIONS
0 BOLTING
FIRM NAME:
INSPECTOR(S):
°CONCRETE
0 REINFORCEMENT
PHONE:
° WELDING
FAX:
IS PUBLIC SEWER AVAILABLE: ° YES 0 NO
1S PUBLIC WATER AVAILABLE: 0 YES 0 NO
IF YES: ° COUNTY 0 CITY
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 0 NO
PSSA: 0 YES ° NO
I DATE:
ISTAFF:
METHOD OF PAYMENT:
0 O
CASH . CHECK
0
BANKCARD #. EXPIRES: V/NAY
AUTHOR/ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD