2003, 10-01 Permit App: BLD-03-02636 Garage C[f!'OF 101.1.1r�3�
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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
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STREET ADDRESS: s 2.,-;) 0 1:77 ,
ASSESSOR'S TAX PARCEL NUMBER(S):-
LEGAL DISCRIPTION: t s2 / l r 1/,y� e7
PERMIT DESCRIPTION: 1„rpoi /p �.'J I, Y
O BUILDING PERMIT D CHANGE IN USE a GRADING a MANUFACTURED HOME
C RELOCATION E SIGN Q TENANT MOTHER
OWNER / APPLICANT INFORMATION f
® OWNER:/_C4 r- ./ (::(TCI O.� ® APPLICANT: '?C U
PHONE: y,2) `30/7 FAX PHONE: S«ri, -P c7J FAX:
ADDRESS: / 3 2 C '- n{ 0 J')-- ADDRESS:
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;9-'cs k-,4,-4 CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: ^- ✓C C ARCHITECT: ,� cf PI C'C/C(/,-i 7:,, /-
✓ ”.PHONE: `r' {j%.Fr'=.5' FAX: S -IS -)3 i F PHONE:
FAX:
ADDRESS: 7--;(, ---T(2) X 2,I 2 ',! ADDRESS:
C,,-/:-20 k c,-a c. : y 1 Cy CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# 1'( J CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: %U CIO U c'Y 30%SLOPES ON PROPERTY: /I, /" MAIN FLOOR SQ FT: ` .
BUILDING HEIGHT TO PEAK: %� OCCUPANCY GROUP: /2% /12ND FLOOR SQ FT: z '/
BUILDING DIMENSIONS: )'/X� (// ' CONSTRUCTION TYPE: ,2-20 '/l'i ':' ''S UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: ,�''•+' FINISHED BASEMENT:
NUMBER of BEDROOMS: /'4'1/.47 CRITICAL AREAS: f l / GARAGE: .S 2(.-/'
/
FLANKING SETBACK: - , CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE: A A'
LEFT SETBACK: CURRENT WELL USE: A, ./
RIGHT SETBACK: ,j v / IMPERVIOUS SURFACE AREA:
IMANUFACTURED HOME SIGN
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
1
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE 1
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I SPECIAL INSPECTIONS
® BOLTING °CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
IBUILDING STAFF USE ONLY 1
IS PUBLIC SEWER AVAILABLE: 0 YES ® NO IF YES: ® COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: 0
YES 0 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 0 NO PSSA: 0 YES 0 NO
DATE: ' STAFF:
METHOD OF PAYMENT:
® 0 ® rte' ® —
CASH CHECK L y. _ VISA
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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