2005, 10-12 Permit App: 05003751 Reroof FROMr: ALPINE CONSTRUCTION FAX NO. : 5094455504 Oct. 10 2005 12:29PM P1
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40,ValleyleJv
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 ,„,,,J •
STREET ADDRESS: / / 9 Z�' C //
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: R-C /2 001
..t LDING PERMTT CI CHANGE IN USE • a GRADING 0 MANUFACTURED HOME
EtRELOCATION 0 SIGN • 0 TENANT 0 OTTFFR
^! • _ OWNER / APPLICANT INFORMATION ' _�_ 1
® GA 2T W�'4" 0 APPUCANT:
OWNER:
PHONE: FAX• PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
CONTRACTOR: 4 1'/' ,N tT c0,-+5% /L)C-T%4^' Q ARCHITECT:
PHONE,Yy°d' SU 9 9 FAX: `j`/3• Crt'y PHONE: FAX:
ADDRESS: Y ViS (-,-)JA44,24--vt, S, wA- 9L 7,3
ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE#
Cr° 0 Ai G 06 8.vi.it1 CONTACT: /JA-/I"v 12-'4"r
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 02 9°Q. 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:- 2ho 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:
OCT 10 2005 12:25 5094485504 PAGE.01
FROM : ALFINE CONSTRUCTION FAX NO. : 5094485584 Oct. 10 2005 12:29PM P2
... . ._.._.'. . __..�_ --- ..._..-_._ _
MANUFACTURED HOME • SIGN
—
WIDTH: _ LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:. .
YEAR: PIT SET: _ #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
L® RELOCATION FIRE S�AFEj Y
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
elw„grimIllel . _...- .,_.._._ - ----- .-
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 ❑CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S): —
_ BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: _ CI YES P NO IF YES: ❑ COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: Q YES CINO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: YES 0 NO PSSA: 0 YES 0 NO
__
DATE: STAFF: __. _. � -----1
- •
-- - ____ This document ongma y
METHOD OF PAYMENT' confidential credit card information which
o 0
0 — 0 agoommil was redacted pursuant to RCW 19.255.010
VISA and the original document destroyed
CASH CHECK pursuant to SOS DAN GS2014-030.
BANI(CARD r ��� VIN
&Af-91AUTHORIZED SIGNATURE.•
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BAdKCARD
OCT 10 2005 12:27 5094485504 PAGE.02