2003, 07-29 Permit App: BLD-03-02095 Deck Cover CM OF
.••cValleY
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: ,c (91/ A /074'.• A 'e-
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: t'Z y / (2 ( ?V-01 6&1)-('2
BUILDING INS PERMIT CI CHANGE IN USE . CI GRADING CI MANUFACTURED How
URELOCATION Q SIGN TENANT aOTRER
OWNER / APPLICANT INFORMATION
® OWNER: Ale -erYZQ-''-az1&=) ® APPLICANT:
PHONE CP% 53 3'S6�(. AX: �1 PHONE: FAX:
ADDRESS: 6#Oy E / /.44V(. J/9O&Z4/e �I'� • ADDRESS:
eg094 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:
PERMIT/BUILDING INFORMATION
COST OF PROJECO369/2—1./g267 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: a COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK: L'
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
IMANUFACTURED 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:
1 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):
1 BUILDING STAFF USE ONLY
I
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: 0 COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: 0
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: ® YES 0 NO PSSA: 0 YES 0 NO
fDATE: ' STAFF:
METHOD OF PAYMENT.,
0 0 0 r
h3a h,cArt7{ MA
CASH CHECK simumm
SANKCARD#; EXPIRES: V/NAS
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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