2004, 03-01 Permit App: BLD-04-03647 Addition , „,,,,,,....
. s Sfilikane
,o, Vey
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
IREQUIRED SITE INFORMATION
STREET ADDRESS: I, /OS 2 1 1 ,5 r1-` C'ioeK L"e.I(c (.",/c-, , ? l 2 c>6
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
p PERMIT SCRIPTION: l .
/ Irl'Aita._
UILDI NG PERI IIT a CHANGE IN USE a GRADING CI MANUFACTURED HOME
RELOCATION D-SIGN 0 TENANT C OTHER
IOWNER / APPLICANT INFORMATION 1
01/
OWNER: --1\-i.r Ali Li hi le 44 (/t .CJ/S h ® APPLICANT: ✓2
PHONE: SCS 1l ¶I :cs 7t,FAX: PHONE: \FAX:
ADDRESS:A, /0.52 ( 6 i'''• 504 i`e,(/ i. ADDRESS:
CITY,STATE, CITY,STATE,ZIP
®CONTRACTOR: 5:e-- l F ® ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
IPERMIT/BUILDING INFORMATION
COST OF PROJEc ': 2QO4 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: 7_5 C,-5
BUILDING HEIGHT TO PEAK: 15 / OCCUPANCY GROUP: PT- 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: 1 L71( CONSTRUCTION TYPE: 'cio et
Fri-.4e•-e____
ri-.4�.
Y` e____ UNFIN BASEMENT: 75E: S��
NUMBER OF STORIES: 1 STRUCTURES ON PROPERTY: 1 I'a '. FINISHED BASEMENT:
NUMBER of BEDROOMS: ' -. CRITICAL AREAS: GARAGE:
FLANKING SETBACK: 3S CURRENT PROPERTY SIZE: / IS 1-/ 7$ ' COVERED DECK: -----e—
'31.6 —
FRONT SETBACK: ✓ " CURRENT PROPERTY USE: (.1✓v=e/l, .lDECK:
REAR SETBACK: 2_ CURRENT SEPTIC USE: St. z r &La
LEFT SETBACK: 7- i / CURRENT WELL USE: 4y'
RIGHT SETBACK: ) IMPERVIOUS SURFACE AREA:
MANUFACTURED 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:
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
I SPECIAL INSPECTIONS
° BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 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: ® YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: YES ® NO PSSA: 0 YES 0 NO
1 DATE: I STAFF: 1
METHOD OF PAYMENT:
® ® ® r 0 imamien
Y
ISA
CASH CHECK
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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