2003, 09-30 Permit App: BLD-03-02628 Remodel ,... , •
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doonalley
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
I
STREET ADDRESS: I E.E. 11- � Ate- \)12., •'L a k-4 ( L J A cti 031
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: P\ckce. .,,+ -G �- 1,./A-s c..A-).,�.j,..-s 1- 4.e.".,�c k .,c ( ✓,c��' -\
w,k,-\ ek t- (..‘L( LA- ✓was ,
BUILDING PERMIT • 0 CHANGE IN USE .ID GRADINGACTURED HOME
RELOCAT o 0-SIGNCI 0-TENANTR
OWNER / APPLICANT INFORMATION
1
91 OWNER:430A--.cL t tatki c., 6�.ti./---C✓ 0 APPLICANT: 4.0-1 L,-%---•-•( .,"� ,^r-,-4-1-
PHONE: _11/41 c3 ,FAX: PHONE: FAX:
ADDRESS: S ct"-~c- `,-S am u•---c_ ADDRESS: S 4-^— --
CITY,STATE,ZIP CITY,STATE,ZIP
® 63
CONTRACTOR: ARCHITECT:
PHONE: FAX: PHONE: FAX: ,.
ADDRESS: ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
IPERMIT/BUILDING INFORMATIONI
COST OF PROJECT: J1005 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 ` . -
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT Or SIGN:
YEAR: PIT SET: . #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: .. TYPE OF SIGN:
e.
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
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY 1
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY 0 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: ® YES 0 NO PSSA: 0 YES ® NO .
DATE: l STAFF: I
METHOD OFPAYMENT••
0 0 0 r 0
h1asp j.+ VISA
CASH . CHECK l — 1111111111.1111111
BANKCARD#: EXPIRES: VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD