2003, 07-30 Permit App: BD03-868 Pool "/
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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: /--Clio 7 ,L/
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: -cWr`r►/ri l rt y P 4 (�h7` 414
erBITILDING PERMIT DCHANGE IN USE I GRADING MANUFACTURED HOME
Q RELOCATION Q SIGN D TENANT DOTHER
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OWNER / APPLICANT INFORMATION
® OWNER: SPY h V t/Di°1 y APPLICANT:
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PHONE: fa 6 " 61 ,wFF .AX: Kati/4
/ PHONE: FAX:
ADDRESS: �3-4'07 4 /q1 90/t � i/4 9903'7 ADDRESS:
/ CITY,STAtE,ZIP CITY,STATE,ZIP
CONTRACTOR: -2 (i��jj f
" 2 /+l�L/1 e1'"�t! a ,Ljk. . ARCHITECT:
PHONE: 3.2 N--30574' FAX: 32s-V77 L PHONE: FAX:
ADDRESS: Oi 0 /Y• / Oh!'°e / ro/ 114 ??..44 ADDRESS:
Q CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE#/I iet/l/C,2 0 9i9I CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 2r 000, 00 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUtDIING HEIGHT TO PEAK: 1/ 2 OCCUPANCY GROUP: 2ND FLOOR SQ FT:
# L FIQ'
3141DIMENSIONS: I(P 1�-J,) CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
FLANKING SETBACK: frc CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
I
RIGHT SETBACK: I IMPERVIOUS SURFACE AREA:
I MANUFACTURED HOME SIGN r
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
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
r _ _
SPECIAL INSPECTIONS I
0 BOLTING °CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO IF YES: COUNTY 0 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: 0 YES 0 NO
IDATE: STAFF:
METHOD OF PAYMENT:
0 0 0 r 0
,iosh,cont VISA
CASH CHECK -
BANKCARD#: EXPIRES: VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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APPROVED BY---74,-- -
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