2003, 11-05 Permit App: BLD-03-02983 Addition striakinto/e\r,
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Ir'" 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: �� 1.1 / irt Oif LoA
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
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PERMIT DESCRIPTION: 0 p ` - czA, ile,
WEUILIMNG.PERMIT - I✓1 CHANGE IN USE .0 GRADING CI MANUFACTURED HOME
0RELOCATION 0-SIGN ®-TENANT 0.O FttER"
OWNER / APPLICANT INFORMATION
® OWNER: '3;-1-f-4- isi J` 0 APPLICANT:
PHONEL ) 9 9 O - cia 1 FAX: g� PHONE: FAX:
ADDRESS: I'- 1S` C. 13 6:2 �.iQ S-V �}'i„v ` iQ.J ADDRESS:
CITY,STATE,ZIP _. CITY,STATE,ZIP
CONTRACTOR; 13ve-(1 Li Pr ® ARCHITECT:
PHONE:Csz 3,7 - 7 31r FAX: & - (Fd(cO PHONE: FAX:
ADDRESS: I IC>I IS r 1 ltp,” 7 / ' ( , UA- $'V le ADDRESS:
// CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# LO.? U�L.t I 07-S CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:I 30, 000 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: 18 OCCUPANCY GROUP: 2ND FLOOR SQ
BUILDING DIMENSIONS: Y1 X 30 CONSTRUCTION TYPE: SVA- UNFIN BASEMENT:
'NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: 1,; i CRITICAL AREAS: GARAGE:t (N9 4.
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 OP SIGN
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
RELOCATION FIRE SAFETY
I
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE f
II
PLANS EXAMINER: PHONE:
FAX:
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: PHONE:
FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS 1
0 BOLTING ®CONCRETE ® REINFORCEMENT a WELDING
FIRM NAME: PHONE:
FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
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IS PUBLIC SEWER AVAILABLE: . ® YES 0 NO IF YES: ° COUNTY a CITY
IS PUBLIC WATER AVAILABLE: a
YES ® NO ' IF.YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES 0 NO PSSA: ® YES 0 NO .
DATE: I STAFF:
METHOD OF PAYMENT:
0 0 ❑ r -- El gimm■ .
CASH CHECK I 'Mil
BANKCARD#‘; EXP/RES. VIN#
AUTHOR/ZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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APPROVED BY 'Alk. _ -
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