2004, 09-30 Permit App: BLD-04-07818 Finish Basement srakano,\,...,e .
_..
Milley
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 -
STREET ADDRESS: / 1 —7 1 l E 4.5 \' 3.2 .cf
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: A a-ge,e....e"4-- f-e.r.oc.I tiC v/111
BUILDING PERMIT ... D CHANGE IN USE C GRADING a MANUFACTURED HOME
a-RELOCATION CISIGN DTENANT C1-0.111ER
OWNER / APPLICANT INFORMATION i
OWNER: C 4.p0\ («Cd4 S ® APPLICANT: 5 G^^.e-,-
----- ---- -
PHONE: Claw{ - q 7'1& FAX: PHONE FAX:
ADDRESS: I I -1 /9 Ea S4 3a.nc ADDRESS:
CITY,STATE,ZIP . CITY,STATE,ZIP
�(bONTRACTOR: ?foCk 1 yl Co tis t'ruc ' 0 ARCHITECT:
PHONE(SO`1) •)30 0c-I I f! FAX: PHONE: ,/\ FAX:
ADDRESS: .0, tr»! 4 tS S S poke, W o., q 6/P t ADDRESS: IL
1 `
CITY,.STATE,ZIP 1 10 i, 0 ITY,STATE,ZIP
90
WA Si CON i RA -UCENTS 0'• • - • CONTACT: NNW
PERMIT/BUILDING INFORMATIO
uc'
COST OF PROJECT -76 76' 30%SLOPES ON PROPERTY: n0 MAIN FLOOR SQ FT: 9 60
BUILDING HEIGHT TO PEAK: /6 OCCUPANCY GROUP: 5i�51c -c.wn;I y 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: 14 X;ZA. CONSTRUCTION TYPE: ICu,elnv- UNFIN BASEMENT: 0--\ a`
NUMBER OF STORIES: 1 STRUCTURES ON PROPERTY: FINISHED BASEMENT: lAC c 4(
NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE: o? CG.-r
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: feesi'lle^ee_ DECK: Yt5
REAR SETBACK: CURRENT SEPTIC USE: C;4-y sewer-
LEFT
einerLEFT 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
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: 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 j
a BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES NO IF YES: COUNTY 0 CITY -
IS PUBLIC WATER AVAILABLE: ® 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: 0 YES 0 NO PSSA: 0 YES 0 NO
IDATE: f STAFF:
METHOD OF PAYMENT:
Ifrbsto.orti VISA
CASH CHECK m
BANKCARDS; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD