2003, 08-21 Permit App: BLD-03-02294 Finish Basement Sö1�e
+/,01Valley
PERMIT APPLICATION P ATION 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
STREET ADDRESS: l O I l ' £ [ 7#1 L/V
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGALDISCRIPTION: Di 5hm() Y) COrnmc nS /VE 1/4 .2,-025- L/y LT pA T3LK
PERMIT DESCRIPTION:
0 BUILDING PERMIT D CHANGE IN USE I GRADING 0 MANUFACTURED HOME
URELOCATION 0-SIGN }TENANT p-OFLIER
OWNER / APPLICANT INFORMATION
"" OWNER: 7C i L+li Marr', ® APPLICANT: Sat ink
k
PHONE: q)-6,-;35U7 ,FAX: PHONE: FAX:
ADDRESS: 10111E' /7A L-/v i aF ka VJ)'ei{ gq..20k,ADDRESS:
ITY,STATE,ZIP - CITY,STATE,ZIP
®CONTRACTOR: ® ARCHITECT.:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
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: I lSV
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
1 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
I
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
1 WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
Ili BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
IBUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO IF YES: ® COUNTY ® 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: I STAFF: '
METHOD OF PAYMENT: 1.,.
0 0 0 r T 0 ..milm
CASH CHECK t7
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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