2003, 09-24 Permit App BLD-03-02567 GaragePERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: I CI Ll 10 t lily-tA1l.Ul
®RELOCATION
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
2-0
PERMIT DESCRIPTION: fret oeir
$UII,DING PERMIT CICHANGE IN USE
Q SIGN
E GRADING
O TENANT
41/
Mgh
® MANUFACTIJRED HOME
1 OTHER
OWNER / APPLICANT INFORMATION
® OWNER: I rtila J///t'L7yr P/4' I /ed
PHONE: Z�J/-59Y Z ���JJFAX: �,I
ADDRESS: "0, ji Z°4 IZ c, 4;6,1I.UFF ?ro30
�f6 / rn ,4. $
CITY,STATE, ZIP
ElCONTRACTOR:. (/('241v
PHONE: 5bO-77 ° ` O % q 7 FAX:
ADDRESS:
CITY, STATE, ZIP
APPLICANT: /CI G gym
PHONE: f 5-3 -3 9Z3 FAX: 727- ,?.37
ADDRESS: /5 '/ 6 rntrOvr
CITY, STATE, ZIP
® ARCHITECT:
PHONE:
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
FAX:
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: /Qf 000
BUILDING HEIGHT TO PEAK: /Sl(
BUILDING DIMENSIONS: 741-/
-
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK: I� /
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30%SLOPES ON PROPERTY: No
OCCUPANCY GROUP:
CONSTRUCTION TYPE: r-r.f. . C
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
CURRENT PROPERTY SIZE: (n/ 70 COVERED DECK:
CURRENT PROPERTY USE: ices) vi, ( DECK:
CURRENT SEPTIC USE: N U
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SO FT OF SIGN: HEIGHT OF SIGN: # OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
FIRE ALARM:
TENT:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE CI REINFORCEMENT CI WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: ® YES 0 NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: CI YES CI NO
IS THE PROPERTY LOCATED WITHIN ASA: CI YES ® NO PSSA: ® YES 0 NO
DATE:
I
METHOD OF PAYMENT:
0 El
CASH CHECK
STAFF:
VISA
BANKCARD # EXPIRES: VIN #
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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