2004, 04-16 Permit App: BLD-04-04099 Lean ToPERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMON/TY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague A ve Ste 106
Spokane Valley, WA 99206 .
Phone: (509)688-0036 Fax: 509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: ' / 3 10 3� T.0 SP0`_ ' v►..�A
ASSESSOR'S TAX PARCEL NUMBERS): 1 S 3 a'O
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: f��'` `1a IO' O Cove R
MDING PERMIT CICHANGE IN USE ® GRADING O MA.NUFACTUIRED HOME
Q RELOCATION []-SIGN 1 TENANT [ OTHER
OWNER /APPLICANT INFORMATION
® OWNER: p2 C r. -N 50.l uk (t -
PHONE: Z FAX:
ADDRESS: �5 A
j� t CITY,STATE, ZIP
CONTRACTOR:_ Uy'" r e. o
PHONE: FAX:
ADDRESS:
CITY,.STATE, ZIP
WA ST CONTRACTOR LICENSE #
COST OF PROJECT:
® APPLICANT:
PHO
ADDRESS:
CITY, STATE, ZIP
13 ARCHITECT.:
PHONE: FAX:
ADDRESS:
- CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS: 16" x 40
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:—S '
30% SLOPES ON PROPERTY: t1j1z1
OCCUPANCY GROUP: V
CONSTRUCTION TYPE: V N
STRUCTURES ON PROPERTY: Y�s
CRITICAL AREAS: 00
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE: S F R'
CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: S / IMPERVIOUS SURFACE AREA: N o
MAIN FLOOR SO FT:
2ND FLOOR SO FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
Give r ; (pyo
MANUFACTURED HOME
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN:
# OF SIGNS:
TYPE OF SIGN:
SIGN
HEIGHT OF SIGN:
AREA OF EXIST SIGN:
RELOCATION FIRE SAFETY
y:
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
II WA STATE NON-RESIDENTIAL ENERGY CODE II
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
13 BOLTING ® CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHO
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 13 NO IF YES: 13COUNTY E3 CITY
IS PUBLIC WATER AVAILABLE: ® YES 13 NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: a YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: [3 YES [3 NO PSSA: 0 YES 0 NO
DATE:
11 STAFF:
METHOD OF PAYMENT.'
Inis aocumentoriginally con arae
`O
confidential credit card information which
Q Q Q
`�/�
�►YM
was redacted pursuant to RCW 19.255.010
and the original document destroyed
CASH CHECK
I
pursuant to SOS DAN GS2014-030.
BANKCARC-, - V _ V/Nj4
AUTHOR/ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
�S% TFi AVe
0 • b
mss
ROAO
FRONT
co
vMrs
O 81r
i
i
1 1
r T��
lJ y, 7 7 f - r
(,
( w6. SeAL E «10'F -