2003, 01-02 Permit App BD03-754 Re-Roofmr \0
jValley
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----PERMIT APPLICATION WORK SHEET
SPOKANE'VALLEY COMMUNITY DEVELOPMENT
117BUILDING DIVISION
7 East Sprague Ave Ste 106
--- Spokane Valley, WA 99206
-Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
4-1 (7 12), vt
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 1Z:, 0z
([] BUILDING PERMIT a CHANGE IN USE CI GRADING
EIRELOCATION
El SIGN ® TENANT
I® MVIANUFACTURED HOME
E OTHER
IOWNER /APPLICANT INFORMATION r
® OWNER:
W
ADDRESS:
(A..t\a_vv‘
® APPLICANT:
PHONE: f Z /- (6 7 FAX: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTRACTOR: E(lr ( F-cf.c±Z Cd r'�C ® ARCHITECT:
PHONE: sl b - 94 7S- FAX: PHONE:
ADDRESS: f�v 4 PD]C 4 Sql2 d it `S CCs('(L" ` Q -S (4.)?a• ADDRESS:
CITY,. STATE, ZIP CITY, STATE, ZIP
/ -0 7 ba/r.'ihvk, ,
CITY,STATE, ZIP
FAX:
WA ST CONTRACTOR LICENSE # ru ;, ! a- d K:1 CONTACT:
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:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE: DECK:
COVERED DECK:
CURRENT SEPTIC USE:
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
FIRM NAME:
INSPECTOR(S):
® REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING 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 0 NO
1S THE PROPERTY LOCATED WITHIN ASA: 0 YES NO PSSA: ® YES ® NO
DATE:
1
STAFF:
METHOD OFPAYMENT.
0 0
CASH CHECK
BANKCARD#: EXPIRES: VIN#
AUTHORIZED SIGNATURE. -
"FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
VISA