2003, 11-20 Permit App: BLD-03-03126 Repair Fire Damage 4
CITY OF 4101111"e\ilkit
.000Valley
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: / g!4; / / 4
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 7 'F_ •/Z'' fr J?/-) — /L 6t k Z.
BUILDING PERMIT . 0 CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
URELOCATION ®SIGN 0 TENANT Q OTHER
I OWNER / APPLICANT INFORMATION
1
D OWNER: \ T \`E1\
® APPLICANT: .N1l
PHONE: FAX: PHONE: >>> C FAX: 53 l -75 I L_
ADDRESS: 1-/-("1-)'k � S54-- ADDRESS: -7c.)``‹ - '
CITY,STATE,ZIP - CITY,STATE,ZIP
®CONTRACTOR: \i . ' E V �C� S�L ARCHITECT:
PHONE: 3 —
`a � ��\Z-
FAX: PHONE: � - ' FAX:
ADDRESS: COCK WO cl 2 4 ._ ADDRESS:
CITY,.STATE,ZIP - CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT: L 1Vrt1 1`\/\`I (-3
PERMIT/BUILDING INFORMATION f
<'-/,_,(1)0()
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
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:
T
1 WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
•
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I SPECIAL INSPECTIONS
I
E3 BOLTING °CONCRETE ® REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
1 BUILDING STAFF USE ONLY 1
1
IS PUBLIC SEWER AVAILABLE: 0 YES ® NO IF YES: 0 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES CI NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES 0 NO PSSA: 0 YES 0 NO
fDATE: I STAFF:
METHOD OF PAYMENT:
0 0 ® rT
VISA
CASH CHECK 3
BANKCARD 41; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD