2004, 11-08 Permit App: 04009037 Remodel4-(,.%).57
PERMIT APPLICATION WORK SHEEIS 0s
SPOKANE VALLEY COMMUN/TY DE VEL OPMENT
((6(
•
BUILD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Va/ley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: i`'19O'4 •30-0) Spo res \Y,(1) 1I ti(„(1�� P9037-
ASSESSOR'S TAX PARCEL NUMBER(S): t"
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
O BUILDING PERMIT
['RELOCATION
11,00 r-�
L] CHANGE IN USE 0 GRADING ❑ MANUFACTURED HOME
�} SIGN Q TENANT
Q OTHER
OWNER / APPLICANT INFORMATION
OWNER: .f'j'{(\YA�.
ADDRESS: LA
APPLICANT:
FAX: PHONE: FAX:
Tki U4+ ADDRESS:
13 ARCHITECT:
°CONTRACTOR:
PHONE: FAX:
CITY,S
AT
, ZIP
ADDRESS:
C!TY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
PHONE: FAX:
ADDRESS:
CONTACT:
CITY, STATE, ZIP
1
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
1
WIDTH: LENGTH: SO FT OF SIGN: HEIGHTOF SIGN' '' -
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER - TYPE OF SIGN:
PREVIOUS ADDRESS '
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING' DATE/TIME:
rWA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:.
CITY, STATE, ZIP
INSPECTOR' PHONE' FAX:
ADDRESS:
CITY, STATE, ZIP
I SPECIAL INSPECTIONS
❑ BOLTING
FIRM NAME.
INSPECTOR(S):
El CONCRETE
.❑ REINFORCEMENT
PHONE:
❑ WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ❑ YES ❑ NO
IS PUBLIC WATER AVAILABLE: ❑ YES ❑ NO
IF YES: ❑ COUNTY ❑ CITY
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: ❑ YES ❑ NO
FDATE:
1
STAFF:
1
METHOD OF PAYMENT:
❑ ❑
CASH CHECK
BANKCARDt EXPIRES- V/N#
AUTHOR/ZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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11W rS 2(400 51, 0itiecl: Sbb
yb;ha MSC 0250
JrlktS ,ZOG —'
atrkaacro 1500
TAu ,biro .300
SMOKE ALARMS SHALL SE INTERCON-
NECTED AND HMD WIRED IN SUCH A
MANNER THAT THE'^ACTIVATION OF ONE
ALARM WILL ACTIVATE "ALL ALARMS.
(BEDROOMS. AREAS -APPROACHING
BEDROOMS, VAULTED CEILING
WRH RISE OF 24 & ON EACH FLOOR)
THESE PI ANSS MUST BE KEPT
ON 11-16 JOB