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