2004, 03-18 Permit App: BLD-04-03804 Addition e 6 1 . -5 K3
400 ValleY
PERMIT APPLICATION WORK SHEET 2 tity
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206.
Phone:(509)688-0036 Fax:(509)688-0037
I REQUIRED SITE INFORMATION
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STREET ADDRESS: �=
ASSESSOR'S TAX PARCEL NUMBER(S): Y; �2 Z T .( Y
,LEGAL DISCRIPTION:
Fr a 1 SiS1 R ' " OX si 1/4 11
PERMIT DESCRIPTION:_,SU S q cps j/e.v t- O /i'e 0-/41 S - I00 -
J
ITILDING PERMIT a CHANGE IN USE a GRADING a MANUFACTURES HO
(RELOCATION ®-SIGN D TENANT ER. �9--C.ii fir fid'
OWNER / APPLICANT INFORMATION
I-
® OWNER: De.U I d 3 Ai( I't ( ® APPLICANT:
PHONE Sa $ l FAX: 1
L � �' �k �'fZ//�/ PHONE: aFAX:
t
ADDRESS: k 310 5� ,,. l/GQel ADDRESS: k 1
L
Se ( F CITY,STATE,ZIP - CITY,STATE,ZIP
®CONTRACTOR: S 1 ® ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
IPERMIT/BUILDING INFORMATION
COST OF PROJECT: f•- •• -lit. 30 SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:-
BUILDING DIMENSIONS:1(9 X 7 (' 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:
IWA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
® BOLTING °CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES NO IF YES: COUNTY CITY
IS PUBLIC WATER AVAILABLE: YES 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 ® NO PSSA: ® YES 0 NO
IDATE: ' STAFF:
METHOD OF PAYMENT::
® ® ® r
M131myice! VISA
CASH CHECK �■�
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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