2004, 01-09 Permit App: BLD-04-03393 Addition s
CITY OF ,
.000Valley
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
IREQUIRED SITE INFORMATION
STREET ADDRESS: //?/7 CJS E-3,
ASSESSOR'S TAX PARCEL NUMBER(S): ii-S-3 3/c /8"9
LEGAL DISCRIPTION:Oar 9 /A 8LOCG,. 2 OP i#1D/k0/g6 2i(j'1 4--Dthrjpid 45 1%.,-/z1)44-11---
-"/16--G=ayr Re-col-do) in) 1(OGur46 `(G 0 F P4,4-TS /� 7 -
PERMIT DESCRIPTION: / X 02 V __.,' ,4-4-61--6--P. /Me/77o a./
IJILDING PERMIT CI CHANGE IN USE CI GRADING CI MANUFACTURED HOME
r LOCATION 0 SIGN r TENANT EI-OTHER
J OWNER / APPLICANT INFORMATION
i
OWNER: JW/A/ 0 VtieW ii/e/ - ® APPLICANT: iLl//i A ‘&-Z/V6 I--
PHONE:57)/ m 1cO FAX: PHONE: P . 7v-6 Iv FAX:
ADDRESS: ASO S/Oeg 4/046 r, 6U* 99x'0'6 ADDRESS:f/Yl4/ 6 .53/19
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CITY,STATE,ZIP O're) <;,,1,,P,#P Ys4�2f ulO CITY,STATE,ZIP
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e
CONTRACTOR:
ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
IPERMIT/BUILDING INFORMATION
COST OF PROJECT: 42,00, v-o 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: t 3 OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: /6 A A (7/ „ CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: 0 CRITICAL AREAS: GARAGE:
FLANKING SETBACK: , ,I w
CURRENT PROPERTY SIZE: COVERED DECK:
� r
FRONT SETBACK: 6.-:5 CURRENT PROPERTY USE: DECK:
REAR SETBACK: 41
" CURRENT SEPTIC USE:
LEFT SETBACK: , %-•I'- 3'7-- CURRENT WELL USE:
RIGHT SETBACK: l lr( IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
I WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO IF YES: ® COUNTY ® 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: ® YES ® NO PSSA: 0 YES 0 NO
IDATE: ' STAFF:
METHOD OF PAYMENT:
® ® ® rTammi
CASH CHECK
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE::
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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