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2004, 09-30 Permit App: BLD-04-07814 Pole Bldg Addition ersokaneoeN... 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: 3 y 0g \ ASSESSOR'S TAX PARCEL NUMBER(S): q S a I e a y (p i x CAE'. ©I - LEGAL DISCRIPTION: 'VI t la 3 ` du S 150 prit F ILL a 6 r— PERMIT DESCRIPTION: i'BUILDING PERMIT O CHANGE IN USE CI GRADING •D MANUFACTURED HOME CI-RELOCATION ®-SIGN Q TENANTEIOTHER- OWNER / APPLICANT INFORMATION D OWNERcA fri ® APPLICANT SCAN_ ergiiaC-or PHONE: (Ti--6 FAX: PHONE: FAX: ADDRESS: R(4 O U �= (S fk'\ ADDRESS: ^� CITY,S1TATE,ZIP CITY,STATE,ZIP °CONTRACTOR: (lOK . �,` OJ Cj a ARCHITECT: DIN ,byDP Q PHONE: po- -`/`;57 FAX: PHONE: !✓��� FAX: ADDRESS: -( }CEJ ()(/I�Q l IR I '`(,t 'ti IS ADDRESS: CITY,.STATE,ZIP CITY,STATE,ZIP WA ST CONTRACTOK LICtNbE `a� -7� ;t • CONTACT: I - PERMIT/BUILDING INFORMATION f COST OF PROJECT: goo Oo 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: BUILDING HEIGHT TO PEAK: 04, OCCUPANCY GROUP: 2ND FLOOR SQ FT: BUILDING DIMENSIONS:0(1 k' (D) CONSTRUCTION TYPE: UNFIN BASEMENT: NUMBER OF STORIES: \ STRUCTURES ON PROPERTY: FINISHED BASEMENT: NUMBER of BEDROOMS: Q 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: MANUFACTURED HOME SIGN 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 SPECIAL INSPECTIONS 0 BOLTING ®CONCRETE ® REINFORCEMENT 0 WELDING FIRM NAME: PHONE: FAX: INSPECTOR(S): I BUILDING STAFF USE ONLY I IS PUBLIC SEWER AVAILABLE: • YES ® NO IF YES: ® COUNTY CITY O 0 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: 0 YES 0 NO PSSA: 0 YES 0 NO IDATE: ' STAFF: I METHOD OF PAYMENT: ® 0 ® VISACASH CHECK IL ' 11111111111111111111111 BANKCARD#; EXPIRES: VIN# AUTHORIZED SIGNATURE: *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD r Draw sketch with dimensions showing: (1 ) property proposed buildings; - (4> distance to property lines arc tem and water supply lines. NORTH � T 'JAY.W 4 . • Jot* onsi....4. FROST 4 COL - - ': ---i. 7 m to Ott/S?' -r Res, This site plan is being submitted for the purpose of obtaining a building permit and is a true and correct t $4 sentation of the propose. All known property lines/dimensions,curb Nn.s.a1ntlMNrs and aIans.nl. have been identigsd; bodies ofrep^�'MMgOMrti" ar+s ' Sired: ,//1 � MiNcal Mrs. Date: SOUTH I hereby ce ify information b i ted is orrect as shown. op. Owner or gent A LAND USE OR STRUC rl • E PERMIT MUST BE O THIS IS NOT A PERMIT. DO NOT WI Your street address will be /3lL6 S /6--XL