2004, 11-24 Permit App 04009180 Sliderdo•OValley
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206.
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: oL i (0 S . Coe zvA LA/ &Rt L� I 6 �, Q9 G1/ ,
ASSESSOR'S TAX PARCEL NUMBER(S): 55I q!� . P''� oz U c/
LEGAL DISCRIPTION: I 2j —171.5 I-. z FJLX 3 e1 6,0 W Pap PL
, 4U sir o R'S ��I E.J'' 1Req Oo9 1� a 7 PG- 3(0, 37 J
PERMIT DESCRIPTION: //51,4LL i / Si__/DEJbooR - WALK D(.(,7'LOW 6, LFt/f1
%BUIEDINGPERMTT . • a CHANGE IN USE • D GRADING
DRELOCATION l}SIGN TENANT
a MANUFACTURED HOME
DOFR...
OWNER / APPLICANT INFORMATION
DOWNEtialii5 c •Joilna OirRAA-r--
PHONE:_509 '1 1�-5?gj FAX:
ADDRESS: oZ/IQ 5 . I.flR13iJJ
CITY,STATE, ZIP
CONTRACTOR: ' "4cR S 71' 7 %x -Z-'`.
PHONE: I" .2"� �o C 01
ADDRESS: /V 1-1 3 a
® APPLICANT: 54M 6 4 5 01,0;JEJS
PHONE: FAX:
ADDRESS:
ARCHITECT:
PHONE:
CITY, STATE, ZIP
FAX:
^� CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # �9 /
) a: % p / CONTACT:
FAX:SIf 937O
ADDRESS:
CITY,.STATE,ZIP .' 7
PERMIT/BUILDING INFORMATION
COST OF PROJECT/,j/q, to 0
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
3O% SLOPES ON PROPERTY:
OCCUPANCY GROUP:•
CONSTRUCTION TYPE:
MAIN FLOOR SQ FT:
2No FLOOR SQ FT:
UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPT(C USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQFTOFSIGN: HEIGHT OFSIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
1
PREVIOUS ADDRESS: •
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
TENT:
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
CI BOLTING
FIRM NAME:
iNSPECTOR(S):
®CONCRETE
CI REINFORCEMENT
PHONE:
CI WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO
0 0
IS PUBLIC WATER AVAILABLE: YES NO
IF YES: ® COUNTY 0 CITY
IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHINASA: 0 YES ® NO PSSA: ® YES ❑ NO
METHOD OF PAYMENT.'
CASH CHECK
BANKCARD Ot,• EXPIRES VIA
AUTHOR/ZED SIGNATURE. -
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD