2003, 12-31 Permit App: BLD-03-03365 RemodelQf1' OP _%k
.jValley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITYDEVELOPMENT
BUILDING DIVISION
11707East Sprague Ave Ste 106
Spokane Valley, WA 99206
11 REQUIRED SITE INFORMATION II
STREET ADDRESS: 19-K 2XZ
ASSESSOR'S TAX PARCEL NUMBER($):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 4ll/1�✓/h Geta �ti .h P>i t/ice O) A%4n
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MUDDING PERMIT M CHANGE IN USE ❑ GRADING E] MANUFACTURED HOME
E]RELOCATION L3 SIGN E]TENANT [}OTHER
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-OWNER/ APPLICANT INFORMATION
OWNER: i ����IL�OI` ® APPLICANT:
PHONE: FLM
AX: 'n PHONE: FAX:
ADDRESS: /O%OZ (5gf� �r y� ADDRESS:
O CITY,STATE, ZIP CITY, STATE, ZIP
rnuroecr..o. - 13 _...
WA ST CONTRACTOR LICENSE
COST OF PROJECT: w/5(
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
ADDRESS:
CITY,. STATE, ZIP CITY, STATE, ZIP
PERMIT/BUILDING INFORMATION
30% SLOPES ON PROPERTY:
OCCUPANCYGROUP:-
CONSTRUCTION TYPE: I -B
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT. PROPERTY SIZE:
CURRENT PROPERTY USE: -"
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2"- FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
COVERED DECK:
MANUFACTURED HOME SIGN
WIDTH: LENGTH: SO FT OF SIGN: HEIGHT OF SIGN:
YEAR: PITSET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
G
PREVIOUS ADDRESS:
PROPOSED
FIRE SAFETY
FIRE SPRINKLER: FIREALARM:
PAINTBOOTH:
FIREWORKS DISPLAY:
BLASTING:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS
DATE/TIME:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
13 BOLTING ®CONCRETE 0 REINFORCEMENT ❑ WELDING
FIRM NAME: PHONE: FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: E3YES 0 NO IF YES: 13 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: ® YES E3 NO IF. YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 13 YES E3 NO
ISTHE PROPERTY LOCATED WITHIN ASA: [3 YES I] NO PSSA: 0 YES 13 NO
0 0 0 00
CASH CHECK '
BANKCARDS, EXP/RES: V/N#
AUTHORIZEDSIGNATURE
'FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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