2003, 08-13 Permit App: BLD-03-02215 Pole Bldg3-2
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99208
Phone: 509 688-0036 Fax: 509 688-0037
STREET ADDRESS: 1/17lR3. F 4/5 TH
ASSESSOR'S TAX PARCEL NUMBER(S):
wgoyz.o6o/
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: Pot c Syejj
BRIDTDING PERMIT - ❑ CHANGE IN USE ID GRADING ®MANUFACTURED HOME
D OTHER
QRELOCATION (SIGN- (TENANT
OWNER / APPLICANT INFORMATION
a OWNER: j PC4WeY S'M 4dm7
q !' I] APPLICANT:
PHONE: / 2 7'3 7 6i /F,AX: PHONE: FAX:
ADDRESS: / / WA -2, i` T'S %� ADDRESS:
j� �L }� CITY,STATE, ZIP CITY, STATE, ZIP
000NTRACTOOR: JS V 1 1J .L)L//QS/44 0 ARCHITECT:
PHONE: 7 7S /205' FAX: PHONE: FAX:
ADDRESS' //EO.- .5; /y/faIfo,/ UiLCr}$i ) ADDRESS:
]CITY, STATE, ZIP[ %/
WA ST CONTRACTOR LICENSE 9 JS L` J A 4t2 % t/,0 CONTACT:
CITY, STATE, ZIP
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 7000 30% SLOPES ON PROPERTY:
BUILDING HEIGHT TO PEAK: aft- OCCUPANCY GROUP:.
BUILDING DIMENSIONS: a HA3O CONSTRUCTION TYPE: ALC
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:.
UNFIN BASEMENT:
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: /56U5 -t FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
FLANKING SETBACK' CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: /D f CURRENT PROPERTY USE: - DECK:
REAR SETBACK: S CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: '� IMPERVIOUS SURFACE AREA:
WIDTH: LENGTH: SQ FT OF SIGN' HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
FIRE ALARM:
TENT:
DATE/TIME'
NWA STATE NON-RESIDENTIAL ENERGYCODE
il
PLANS EXAMINER: PHONE:
FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
N SPECIAL INSPECTIONS
o BOLTING
FIRM NAME:
INSPECTOR(S):
°CONCRETE
0 REINFORCEMENT
PHONE:
CI WELDING
FAX:
r
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO
CI
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
ISTHE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO ' PSSA: 0 YES 0 NO
IF YES: • COUNTY ▪ CITY
II DATE: [STAFF:
METHOD OF PAYMENT:
O 0
CASH CHECK
o
0
BANK CARD A` EXP/RES: VIN0
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
1 p go?O'S-9
491-4
3d
I
A PROVE®6Y 71( She*