2004, 11-04 Permit App: 04009019 Tear Off, Reroof *lane A V
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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
1
REQUIRED SITE INFORMATION
STREET ADDRESS: f/ q/7 5!6
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 71-Z9 v -/ -7
UILLDING PERMIT [,�CHANGE IN USE 0 GRADING D MANTJI ACTURED HOME
0-RELOCATION 0-SIGN 0-TENANT DOFILER
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OWNER I APPLICANT INFORMATION
CI OWNER: ® APPLICANT:
PHONE: FAX: PHONE:
FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
CONTRACTOR: de- � Q ARCHITECT:
PHONE: wO G FAX: ,3 - _/96o 5' PHONE: FAX:
ADDRESS: j k/g- ��, �LG I Gt_ _C/) 7c»'1 ADDRESS:
CITY,STATE,ZIP V} CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# POO jLC &) ill CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 64-0 e---e) 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: IJNFIN 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:
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:
t WA STATE NON-RESIDENTIAL ENERGY CODE 1
PLANS EXAMINER: PHONE: FAX:
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS I
® BOLTING °CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY l
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO IF YES: COUNTY 0 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: 0 YES 0 NO PSSA: 0 YES 0 NO
IDATE: ' STAFF:
METHOD OF PAYMENT:
0 �t
® 0 ® 1 VISA
CASH CHECK L -.
BANKCARD#,. EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD