2003, 10-22 Permit App: BLD-03-02872 Finish Basement CITY OF 00111.1r NIIIIIk ., .
e
.000Valley
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
STREET ADDRESS: )5511 E 2151- a Spoiame Va.1if 1 W 9c1b3
ASSESSOR'S TAX PARCEL NUMBER(S): v
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: -pivilqiiiiibet,lerinfoi-
0 BUILDING PERMIT a CHANGE IN USE a GRADING a MANUFACTURED HOME
DRELOCATION 0-SIGN D TENANT 0-OTHER
IOWNER / APPLICANT INFORMATION
1
® OWNER: e 4- b(?i 0011 1---i f / 0 APPLICANT:
PHONE: t)CIZ- S5(O FAX: PHONE: FAX:
ADDRESS: 15511 E, 215+. a Spok-cneValle9 ADDRESS:
CITY,STATE,ZIP . CITY,STATE,ZIP
®CONTRACTOR: at)ae' 0 ARCHITECT:
PHONE: FAX: PHONE:
FAX:
ADDRESS: ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
IPERMIT/BUILDING INFORMATION
COST OF PROJECT: IuUU. GO 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:
IMANUFACTURED HOME SIGN 1
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
IRELOCATION FIRE SAFETY 1
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
I 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 f
® BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
I BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: ® YES 0 NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 0 YES ® NO
IDATE: 1 STAFF: '
METHOD OF PAYMENT:
® a O r
alt&cer7
. VISA
CASH CHECK
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD