2003, 07-07 Permit App: BLD-03-02026 Poolvicral or, 00-00^Nwoh
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SPOKANE VALLEY COMMUNITYDEVELOPMENT
BUILDING DIVISION
19707 East Sprague A ve Ste 106
Spokane Valley, WA 99206
Phone. (509)688-0036 Fax (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 2-, V
ASSESSOR'S TAX PARCEL NUMBER(S): q
LEGAL
PERMIT DESCRIPTION:
0 BUILDING PERMIT 1 CHANGE IN USE E GRADING El MANUFACTURED HOME
13RELOCATION 1 SIGN [ TENANT MOTHER
OWNER /APPLICANT INFORMATION
® OWNER:
PHONE: ! I FAX: J
ADDRESS: b_Z 0C E 1-7 c�'C 1 7- , i�•y{l rf%}
CITY,STA IP
® APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
®1��L -
CONTRACTOR: �L�Cx,I S l ® ARCHITECT.:
PHONE:,�TI FAX: �� `l Z)/�� PHONE: FAX:
ADDRESS).-`% �% /L/, L2�16��� t�V�-� ADDRESS:
CIT1��. T z- I Zig CITY, STATE, ZIP
WA S C NTRACTOR LICENSE # 14-16 Q'. i41 A4 / 3 CONTACT:
COST OF PROJECT: 2-01 e
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
i
FRONT SETBACK: X70
REAR SETBACK: Z� I
ri
LEFT SETBACK:
RIGHT SETBACK:
PERMIT/BUILDING INFORMATION
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:_
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
109- OAW�
1 50
MANUFACTURED HOME
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN:
# OF SIGNS:
TYPE OF SIGN:
SIGN
HEIGHT OF SIGN:
AREA OF EXIST SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
I WA STATE NON-RESIDENTIAL ENERGY CODE II
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
INSPECTOR: PHONE:
ADDRESS:
CITY, STATE, ZIP
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAMI
INSPECTO
PHONE:
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® COUNTY a CITY
IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES, WHICH WATER DISTIIRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: a YES ® NO
DATE: 'I STAFF:
METHOD OF PAYMENT.•
® ® ® ® y1m
CASH CHECK , ' w
BANKCARD# EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD