2003,07-16 Permit App: BD03-780 Reroof arY 41111.1\1111111„ ri/7a 7--1 nY"1"71:C771 4 7_/e .03 ".\-----77-,- _____
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40011 ValleY PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUN/TYDEVELOPMENT
BUILDING DIV/S/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
I REQUIRED SITE INFORMATION
STREET ADDRESS: 11 3.).i C , 5 r Spa1,i.Q0W4 `toCA O [,
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: kve,es
El IJILDING PERMIT a CHANGE IN USE a GRADING 0 MANUFACTURED HOME
[RELOCATION 0 SIGN Q TENANT D OTHER
OWNER / APPLICANT INFORMATION ,A
D OWNER: Al '\A k'L{V'. ® APPLICANT:
PHONE: ct4_ -a 4L-0 FAX: PHONE: FAX:
ADDRESS: i 13 al C ` 3`7 *.teic/40 UJA Yia6 ADDRESS:
ITY,STATE,ZIP CITY,STATE,ZIP
t A _
CONTRACTOR: P.....1._ �oc i L, ARCHITECT:
PHONE: Ci,)...q 3n k FAX: CI BCS, 3-7(513 PHONE: FAX:
ADDRESS: PO hr,sc_ I I-(1 pt
Ll 14 lal11 ADDRESS:
ITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# +E 4*-k I 41(1,113 3 CONTACT:
IPERMIT/BUILDING INFORMATION
COST OF PROJECT: 3 q b® 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: 1 S' OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: I 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:
( -7, z3-
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: 9- 93
IMANUFACTURED HOME SIGN I
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:
WA STATE NON-RESIDENTIAL ENERGY CODE I
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 1
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: 0 COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 0 YES 0 NO
DATE: STAFF:
METHOD OF PAYMENT:
CASH CHECK t ycsfil A
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD