2004, 03-01 Permit App: BLD-04-03648 Shop CITY OF ii,e\111146,
.000Valley
PERMIT APPLICATIONWORK W RK 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: t i / /q a_3 JZd (�
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: A O i
U BUILDING PERMIT a CHANGE IN USE U GRADING CI MANUFACTURED HOME
I RELOCATION Q SIGN ®TENANT Q OTHER
OWNER / APPLICANT INFORMATION
® OWNER: Ake (T/ 7c/2 ® APPLICANT:
PHONE: g12--2-73--/79 FAX: PHONE: FAX:
ADDRESS: /q7/4' , 2 3 /t cl C T ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: $Cf f ® ARCHITECT:
PHONE: // / fF/AX: G� PHONE: FAX:
ADDRESS: 573/�a J� e Wilk./ t1'/ / �t 3 7 ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: i!5tW 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: 1(13 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 rt ` SIGN T I
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:
1 WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
C SPECIAL INSPECTIONS
® BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: ® COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: ® YES 0 NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO PSSA: 0 YES 0 NO
IDATE: I STAFF: I
METHOD OF PAYMENT:
® 0 ® rte, ® v
ISA
CASH CHECK
BANKCARD#; EXP/RES: V/NAE
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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PLANNING DEPT. APPROVED
, .
DATE: 6 • D (.°41
I
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