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2004, 11-01 Permit App: BLD-04-08114 Addition aStiolian'?"` ..�'`Ma11ey PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUNITY DEVELOPMENT • BUILDING DIV/S/ON 11707 East Sprague Ave Ste 106 Spokane Valley, WA 99206. Phone:(509)688-0036 Fax:(509)688-0037 REQUIRED SITE INFORMATION STREET ADDRESS: ! (p F / "4// c iI2 /0/9 ,-C -5226 ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: PERMIT DESCRIPTION: /0 D BUILDING PERMIT a CHANGE IN USE I ]GRADING 1 ]MANUFACTURED HOME 0-RELOCATION Q SIGN 0-TENANT O.HtR OWNER / APPLICANT INFORMATION A - - 0 OWNER: '�L_u/ f ,Ij€/�S'_ _ _ El APPLICANT: PHONE: /ZS 7c,'Y FAX: /�K2. PHONE: FAX: ADDRESS: xi.R ay H / ADDRESS: a SP�4 t 0" ly7C1 STATE,ZIP CITY,STATE,ZIP CONTRACTOR: / ��// ARCHITECT: PHONE: FAX: PHONE: FAX: ADDRESS: ADDRESS: CITY,STATE,ZIP CITY,STATE,ZIP WA ST CONTRACTOR LICENSE# CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT: 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 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: IMANUFACTURED 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: I • RELOCATION FIRE SAFETY I PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM: PAINT BOOTH: TENT: PROPOSED USE: FIREWORKS DISPLAY: BLASTING: DATE/TIME: IWA STATE NON-RESIDENTIAL ENERGY CODE _..............i 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): IBUILDING STAFF USE ONLY - ........j IS PUBLIC SEWER AVAILABLE: 0 YES NO IF YES: 0 COUNTY 0 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 ❑ NO IDATE: I^ STAFF: I METHOD OF PAYMENT: 0 0 ® r T 0 ..ommi :mastietZeti, VISA CASH CHECK L anomav BANKCARD;It EXPIRES: VIN# AUTHORIZED SIGNATURE: *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD . I L6....„, Co irtt r--- k_f) ADDRESSX, i42te4a • ' __ _L________________)t_' . _ -,_.---- , ZONE 1 i I ROAD WIDTH 400 Op, FRONT 2. FLANKING . 0... 1 - COMMENTS REVIE D lir —....., I t 1 it„ t 5 1 4 1 )ki N1... ......." 3 III uciT-c4uca''' ,.)... --_,-- ili d 1 . 0 .. 0 ft q IT ci ii ,J :..:.; r` 17r 1 ir«..•- ,...... ‘C ,...; C..) ._____......._ ........ .„........_.....„. , . — i I 0 fi -.7 i . 1 .... i .c.'.' , ts4 \-----' c--3' — 0 c , I I , 11 „. I I 1 I l L ft, „ smq cii!i-n^:itctfN t,P n7C---f--`of 143 DC7 (:)>' !Lt*irIng::i bumg permli,a,A iF.,, ,... •,,,, ,, r,,,:i corrF,ot 44"--., rTpresentation of the proposal, All knf.-..,,,-,trl oroperi-y 1 q :-.---- v) „.:,..,_.,. ii,esiii:meri ,c) 3,ouft,lir,e,;, ' 'rucTurE.,,,.,,,,,,,-,,J e ,,m,,::,,II'S have b€,En i,:j. tiled. t'lso i lc,ated are.,,,,,eliand,-_-•,, bodics of wati.. :-.•Fee; slo • 'oUiti,r crilical "treaS, Ssgr,e,t t•-•);-- , _ ) 1 bli• qc, I fEL e i `/Al.F ire Li..... 11') V lir 10"11 'P*03 r ki I �/ i n` /-1 -if . -------- , 8.2 3�� POST pry 6` Pow2 X q W ALL_