2004, 11-30 Permit App 04009217 BasementKa n e
,;oOValley
STREET ADDRESS:
ASSESSOR'S TAX PARCEL NUMBERS
LEGAL DISCRIPTION:
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`iBUILDING PERMIT
RELOCATION
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
91707 East Sprague A ve Ste 106
Spokane Valley, WA 99206
Phone. (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
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❑ CHANGE IN USE 0 GRADING ❑ MANUFACTURED HOME
1] SIGN [JTENANT E}OTHER
OWNER / APPLICANT INFORMATION
13 OWNER: S t'
ll
PHONE:.Dy 292 �S �� FAX:
ADDRESS: 0
A
r odj CITY,,$TATE, ZIP
CONTRACTOR:_
PHONE: FAX:
ADDRESS:
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
13 APPLICANT:
PHONE:
ADDRESS:
I
❑ CITY, STATE, ZIP
ARCHITECT:
PHONE: FAX:
ADDRESS:
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: IS
OD
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:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT. PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
CITY, STATE, ZIP
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
MANUFACTURED HOME
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN:
# OF SIGNS:
TYPE OF SIGN:
SIGN
HEIGHT OF SIGN:
AREA OF EXIST SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINE
ADDRESS:
INSPECTOR:
ADDRESS: -
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:_
INSPECTOR(S):_
[3CONCRETE
PHO
PHONE:
REINFORCEMENT
PHONE:
FIRE ALARM:
TENT:
DATEITIME:
FAX:
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: O COUNTY 13 CITY
IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES, WHICH WATER DISTIIRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: 13 YES ® NO PSSA: ® YES ❑ NO
ILDATE. STAFF:
METHOD OF PA YMENT,'
0 ® ® ® y -
CASH CHECK
BANKCARD # EXPIRES; VIN AE
AUTHORIZED SIGNATURE.•
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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INTERIOR AUTER004. gaNrlS OR 110P IOIN
IRIMG A 1081 IT OGI M. OR wEN ONE OR MDNE
'Im ROOD ARE MOOR CR)M m EINI im
LMIBS, THE DIIAUM UOT JW OE PROVDED
SMOKE ALARM NOCIMEO AS EOR IlIE1N
SM KE ALARMS SHALL BE INTERCON-
TEO AND HARD WIRED IN SUCH A
MANNER THAT THE ACTIVATION OF ONE
ALARM WILL ACTIVATE ALL ALARMS.
(BEDROOMS, AREAS APPROACHING
BEDROOMS, VAULTED CEILING
WITH RISE OF 24' & ON EACH FLOOR)
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