2004, 02-04 Permit App BLD-04-03500PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
? 1707East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: � S CO (Zb i n L a e, ��E�J��L P�' J 1 `�GJ YI qr� D 1 (0
ASSESSOR'S TAX PARCEL NUMBER(S): S S 1 1 2„ 24 01
LEGAL DISCRIPTION:
f iv, No 27 of IcA.. S t Q s
PERMET DES-CRIPTION: • �," i S�.'� „ti p e r
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EIIILDING PERMIT . • D-CHANGE IN USE GRADING
CI MANUFACTURED HOME
RELOCATION Et SIGN E TENANT MODEM ��S A- 4---
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OWNER / APPLICANT INFORMATION
i
NER:-`}V1'F v-rN AI U.[. YCl.
PHONE: ?A l 5:3t1y . FAX: A)
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ADDRESS: ��`a �. LLD-NIn (L`--naQeS t1/4)
CITY,STATE, ZI
•CONTRACTOR:
PHONE: FAX:
ADDRESS:
CITY,. STATE, ZIP
PPLICANT: N Cr-1 �l���zeL.i1t
To PHONE: V.4.1. j FAX:
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T(�8
oib ADDRESS:e Q�3 �1�: 010(0[Co
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
ARCHITECT:
PHONE: FAX:
ADDRESS*
CITY, STATE, ZIP
CONTACT:
r
PERMIT/BUILDING INFORMATION
kCOST OF PROJECT: Sow 30% SLOPES ON PROPERTY:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
kc NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
OCCUPANCY GROUP:.
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
'1;00w+n-S I CA.LAREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
4 UNFIN BASEMENT:
�- tu,`ge/t__
FINISHED BASEMENT: ► 2-003'
w
COVERED DECK:
DECK:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT or SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN: J
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS D ' PLAY:
BLASTft4g: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERG)G-CODE
PLANS EXAMINER:
ADDRESS:. •
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INS ECTIONS
o BOLTIN
®CONCRETE
® REINFORCEMENT ® WELDING
FIRM NAM, ' PHONE: FAX:
7
I NSPECTOR(S):
i
IBUILDING STAFF USE ONLY
i
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: ® YES ® NO
IS THE PROPERTY LOCATED WITHINASA: YES NO PSSA: ® YES ® NO
STAFF:
ME7710'7 OF PA VMg'NT'
O 0 0
CASH CHECK
WSA
BANKCARD#; EXPIRES: V/N#
AUTHOR/ZED SIGNATURE,:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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OMPLIANCE
REVIN VALLEY BUILDING DIVISION
EWED FORcc�� '
EXHAUST FANS
100 CFM kitchen
50 CFM bathrooms
&.laundry ���;
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THESE PLANS
ON T MUST BE K
HE JOB SITE KEPT