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2003, 08-05 Permit App: BLD-03-02153 Pool Sliolialve'\'' ,. Val '. 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 I STREET ADDRESS: i/ © 6 9,5 `/W C L 766, ASSESSOR'S TAX PARCEL NUMBER(S): Li 5 , 3 j LEGAL DISCRIPTION: PERMIT DESCRIPTION: 56.,/m 04/-0 . .le Pcr•i.-✓'7- CI Y7-4, t(BUILDING PERMIT O CHANGE IN USE a GRADING •0 MANUFACTURED HOME }RELOCATION °SIGN ®-TENANT 0-OTHER I OWNER / APPLICANT INFORMATION 1 ° OWNER: DGL•9n-� Az--c-„v 4'Lnt� 0 APPLICANT: PHONE: /..12 ?7 FAX: PHONE: FAX: ADDRESS`// Z P . ?S 7 SP's..Ji-4--4. 1.120.6 ADDRESS: /_ .�CITY,STATE,ZIP . CITY,STATE,ZIP ®CONTRACTOR: r1'—'/v P 7/ e � G d -- 0 ARCHITECT: PHONE: /�f P.-2s/ FAX: PHONE: FAX: ADDRESS:/0 2ti2 e ,d S /79'S;oOly) cvq. j ADDRESS: CITY,"STATE,ZIP CITY,STATE,ZIP WA ST CONTRACTOR LICENSE# ,C PSCC a 4.1%).-2„. CONTACT: IPERMIT/BUILDING INFORMATION COST OF PROJECT: 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 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: IWA STATE NON-RESIDENTIAL ENERGY CODE PLANS EXAMINER: PHONE: FAX: ADDRESS: CITY,STATE,ZIP INSPECTOR: PHONE: FAX: ADDRESS: CITY,STATE,ZIP 1 SPECIAL INSPECTIONS 0 BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING FIRM NAME: PHONE: FAX: INSPECTOR(S): BUILDING STAFF USE ONLY I IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: 0 COUNTY ® 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 ® NO PSSA: 0 YES ® NO DATE: STAFF: I METHOD OF PAYMENT.` 0 0 0 r ;64,,,hycsvi VISA CASH CHECK BANKCARD#f; EXP/RES. VIN# AUTHORIZED SIGNATURE: *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD �►1 BOBBY'S IMPERIAL POOLS 10718 E. 25TH SPOKANE, WA 99206 (509) 921-2251 4! c , -Z�L -T P r-,,, °sa -:Iy