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2004, 09-24 Permit App: BLD-04-07752 Remodel��a11ey PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUNITY DEVELOPMENT - BU/LDING DIVISION 11707 East Sprague Ave Ste 106 Spokane Valley, WA 99206... Phone: (509)688-0036 Fax: (509)688-0037 REQUIRED SITE INFORMATION STREET ADDRESS: / 7 //(p E ASSESSOR'S TAX PARCEL NUMBER(S): 5 Z (p �i e2/ LEGAL DISCRIPTION: V M iC 4 .8 -z /9 e / ? / , 2 7 rt- r oy i z / FS' 7- ✓ ; or PERMIT DESCRIPTION: - »UILDING PERMIT DERANGE IN TJSE CI GRADING D MANUFACTURED HOME ©-SIGN QTENANT CI -RELOCATION OWNER / APPLICANT INFORMATION OWNER: t L e r- t 1 APPLICANT: 5 /v7' PHONE: O a- Pi 6_ E FAX: PHONE: FAX: 7 ADDRESS: /41 / tv e `I ADDRESS: CITY,STATE, ZIP CITY, STATE, ZIP CONTRACTOR: PHONE: FAX: EI ARCHITECT: PHONE: ADDRESS: ADDRESS: CITY, STATE, ZIP WA ST uuNTRAICTORICCENSE $ FAX: CITY, STATE, ZIP CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT: it 6,& BUILDING HEIGHT TO PEAK: BUILDING DIMENSIONS: NUMBER OF STORIES: NUMBER of BEDROOMS: FLANKING SETBACK: FRONT SETBACK: REAR SETBACK: LEFT SETBACK: RIGHT SETBACK: G 30% SLOPES ON PROPERTY: OCCUPANCY GROUP: CONSTRUCTION TYPE: MAIN FLOOR SQ FT: 2N0 FLOOR SQ FT: UNFIN BASEMENT: STRUCTURES ON PROPERTY: FINISHED BASEMENT: CRITICAL AREAS: GARAGE: CURRENT PROPERTY SIZE: COVERED DECK: CURRENT PROPERTY USE: DECK: CURRENT SEPTIC USE: CURRENT WELL USE: IMPERVIOUS SURFACE AREA: 1 MANUFACTURED HOME SIGN WIDTH: LENGTH: YEAR: PIT SET: MANUFACTURER: SQ FT OF SIGN: HEIGHT OF SIGN: # OF SIGNS: AREA OF EXIST SIGN: TYPE OF SIGN: RELOCATION FIRE SAFETY PREVIOUS ADDRESS: PROPOSED USE: FIRE SPRINKLER: FIRE ALARM: PAINT BOOTH: TENT: FIREWORKS DISPLAY: BLASTING: DATE/TIME: WA STATE NON-RESIDENTIAL ENERGY CODE I PLANS EXAMINER: PHONE: FAX: ADDRESS:. CITY, STATE, ZIP INSPECTOR: PHONE: FAX: ADDRESS: CITY, STATE, ZIP SPECIAL INSPECTIONS 1:1 BOLTING FIRM NAME: INSPECTOR(S): ®CONCRETE ® REINFORCEMENT PHONE: ® WELDING FAX: 1 BUILDING STAFF USE ONLY IS PUBLIC SEWER AVAILABLE: ® YES Cl NO IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES: ® COUNTY ® CITY 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 ® NO PSSA: 0 YES 0 NO I DATE: STAFF: 1 METHOD OF PAYMENT:: CASH CHECK VISA BANKCARD #; EXPIRES: VIN # AUTHORIZED SIGNATURE. *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD