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2004, 01-20 Permit App: BLD-04-03422 Siding 4 an OF ; 400101ValleY 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 I REQUIRED SITE INFORMATION 1lq STREET ADDRESS: , 7` / ,> ( 1 '` I1 c.j Q ASSESSOR'S TAX PARCEL NUMBER(S): Li 5-1)- 3, -51)0 `t' LEGAL DISCRIPTION: PERM T DESCRIPTION: BUILDING PERMIT a CHANGE IN USE a GRADING a MANUFACTURED HOME [}RELOCATION ®SIGN D TENANT —O tHER OWNER / APPLICANT INFORMATION t ® OWNER: V (-0 V,rnt ® APPLICANT: PHONE: FAX: PHONE: FAX: ADDRESS: / / 4� e I / .. i-14 II (, e ADDRESS: CITY,STATE,ZIP . CITY,STATE,ZIP °.CONTRACTOR: 4 S f 0 lass Sr G V1/' ® ARCHITECT: PHONE: r 2 d? - 6& 13 FAX: / PHONE: FAX: ADDRESS: I Q s / ? S, L 0 1 Or , ADDRESS: L IZ Ev( ± (4) b4 Cj 4,00, CITY,STATE,ZIP CITY,STATE,ZIP WA ST CONTRACTOR LICENSE# I S r C L g 4 t 73 c 7 CONTACT: r I PERMIT/BUILDING INFORMATION COST OF PROJECT: /c-OU ' 0 0 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 STORtES: STRUCTURES ON PROPERTY: FINISHED BASEMENT: NUMBER of BEDROOMS: CRITICAL AREAS: nAptinP• 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 WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT Or 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 I SPECIAL INSPECTIONS BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING FIRM NAME: PHONE: FAX: INSPECTOR(S): BUILDING STAFF USE ONLY IS PUBLIC SEWER AVAILABLE: . ® YES ® 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: 0 YES 0 NO • . PSSA: 0 YES 0 NO IDATE: ( STAFF: METHOD OF PAYMENT: tsbYcams iWU CASH CHECK f_. � BANKCARD#; EXPIRES: VIN# AUTHORIZED SIGNATURE: *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD