2003, 09-22 Permit App: BLD-03-02555 Demo Residence . .
SOlian"'e\"
.000l J
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
1 REQUIRED SITE INFORMATION
•--
I
STREET ADDRESS: 113/7 /6-1-4' 42''e4Qa-rc--4,1 e
flog
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: D,0/ '1649s.e
a BUILDING PERMIT CI CHANGE IN USE C GRADING CI MANUFACTURED HOME
QRELOCATION D SIGN O TENANT D-OTHER
lOWNER / APPLICANT INFORMATION
® OWNER: 5 -6-R6-Ely kuc"--fv ® APPLICANT:
PHONE: sCQ 9g7-95 746 FAX:
``1hSPO Goo C/91'C/91' PHONE: FAX:
ADDRESS: q/13/7 ' /1/4 Qq?-76' ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: 0 ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
L
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:
I 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 j
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 I
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY 1
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: ® YES ® NO
IDATE: I STAFF:
METHOD OF PAYMENT:
T
® CASH ® CHECK ® ® VISA
BANKCARDS; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD