2003, 12-18 Permit App: BLD-03-03310 Repair Fire Damage .,#�
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUN/TYDEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
REQUIRED TE NORMATION
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STREET ADDRESS: /2 S /( L �UJTL, S(30e.nc(L c - t1' a2/�;;
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: r-,)0,c.= srC/z,r) r 4�(
GILDING PERMIT 0 CHANGE IN USE a GRADING U MANUFACTURED HOME
®RELOCATION ®SIGN aTENANT [}OuHER
OWNER / APPLICANT INFORMATION
O OWNER:C-�iF- ST c):61k a,2 h(-erz k'N k./ ® APPLICANT: ( 'l 4'/0c To JZ
PHONE: FAX: PHONE: FAX:
ADDRESS: /, S' // L /�� 7 (1 ���/�/ac1r. c.i4 4'7,21(•' ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR://' �-e� c�j? 6-15'4 6k C ® ARCHITECT:
PHONE: e-g3--c'00/ FAX: k 3"='.)O w PHONE: FAX:
ADDRESS:/ 06);,26)G /L4'o S c-;i r foo Sf' %C9.l'- J`j-ADDRESS:
CITY,.STATE,ZIP i�cy -4 CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE#6('I Fc',-, ''70 13.3- CONTACT: L'u2 c' i2 / C i' I E
PERMIT/BUILDING INFORMATION
COST OF PROJECT 7,00(.-) 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:
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:
I RELOCATION FIRE SAFETY
I
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA 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 ® REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
IBUILDING STAFF USE ONLY I
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: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 0 YES 0 NO
IDATE: ' STAFF: '
METHOD OF PAYMENT:
® 0 0 r i 0 �.
WSA
CASH CHECK a■i■ina
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD