2003, 11-26 Permit App: BLD-03-03150 Finish Basement CITY OF010":11411111% ` 5 so
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400Valley
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
REQUIRED SITE INFORMATION
1
STREET ADDRESS:
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
►� 'UILDING PERMIT CI CHANGE IN USE D GRADING •O MANUFACTURED.HOME
URELOCATION 0-SIGN Q TENANT D OTHER
OWNER / APPLICANT INFORMATION
1
7. OWNER: #Pr-`' IA) "' "Tu s ® APPLICANT:
Spy 9g C)-.1 '1 2
/PHONE: C /( 70 3`l cZ FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,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: OO 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: (6,DU
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: - y 2ND FLOOR SQ FT: 3&°
BUILDING DIMENSIONS: 3b XZZ CONSTRUCTION TYPE: 3100 K UNFIN BASEMENT:
NUMBER OF STORIES: Z STRUCTURES ON PROPERTY: 64 Rik-el- FINISHED BASEMENT:
NUMBER of BEDROOMS: Z CRITICAL AREAS: l� VLtiti GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK: /9 X l0
REAR SETBACK: CURRENT SEPTIC USE: sae-
LEFT
e-LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
IMANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
I RELOCATION FIRE SAFETY
I
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
I WA STATE NON-RESIDENTIAL ENERGY CODE
I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
1 SPECIAL INSPECTIONS I(
f
1:1 BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
I BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES ® NO IF YES:IF ® 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 ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES 0 NO PSSA: 0 YES 0 NO
IDATE: I STAFF:
METHOD OFPAYMENT:
0 0 O r 0 immomm
fRIshyarri: VISA
CASH CHECK k. — isimum
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE: dAjAei
fZc 64--J-----
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD