2003, 10-28 Permit App: BLD-03-02915 Remodel simano.,\,,e ,
4.00Valley
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
I REQUIRED SITE INFORMATION
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STREET ADDRESS: / 0 7 r C Tc 1
ASSESSOR'S TAX PARCEL NUMBER(S): / '_4 6 2 , 7�`�.CJ
LEGAL DISCRIPTION: 1- t. // I J 5 T I'*b i Q g L; I
?Altrm,t.c7. '" G.0 .
PERMIT DESCRIPTION: 4Ttac_14e, ( 1.111114111.1a 6.02-\''‘1:1')rt 1 .
0 BUILDING PERMIT 0 CHANGE IN USE 0 GRADING a MANUFACTURED HOME
CI-RELOCATION 0 SIGN 0 TENANT Q OTHER-
OWNER / APPLICANT INFORMATION , i
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® OWNER:
�APPLICANT: ��red,J, YV1c
PHONE: 'jc:lj- '11.27--7)3?-t-}5- FAX: ?',a 1--6, &.5 PHONE: :32-7-,_35---
FAX: /- '& s'
ADDRESS: I-f 5'i/.;:: "C7. 51 :i1%vv tui//'.t/W/f S G ,ADDRESS:
r/ CITY,STA'1'E,ZIP CITY,STATE,ZIP
®CONTRACTOR: 1-recf /Q`.& u ' 0 ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
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Y
COST OF PROJECT: 6200 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK:.. OCCUPANCY GROUP: /-C..:? 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: 4? UNFIN BASEMENT: ''."5F°''��
NUMBER OF STORIES: STRUCTURES ON PROPERTY: / FINISHED BASEMENT: °`
NUMBER of BEDROOMS: CRITICAL AREAS: ''tea GARAGE: --""*..-..–
FLANKING
-'�FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
l
FRONT SETBACK: 3- CURRENT PROPERTY USE: 'S r DECK: f
REAR SETBACK: '7 3 . ., CURRENT SEPTIC USE: " I t/ "��
LEFT SETBACK: . -4- CURRENT WELL USE:
RIGHT SETBACK: 3 / 5 r
IMPERVIOUS SURFACE AREA:
IMANUFACTURED 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 I
0 BOLTING ®CONCRETE ® REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
1 BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO IF YES: 0 COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: 0
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 Q NO
IDATE: I STAFF:
METHOD OF PAYMENT:
CASH CHECK mom=
BANKCARO#; EXPIRES: VIN#
AUTHORIZED SIGNATURE*
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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DATE: 10e!/o2 o3 i d ��
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