2003, 10-08 Permit App BLD-03-02717 Sitting Room e 6 ,)-?[?
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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
I REQUIRED SITE INFORMATION
STREET ADDRESS: c , -1 4 Z.--Ale.
ASSESSOR'S TAX PARCEL NUMBER(S): ' / 7 J( 00
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
UILDIWG PERMIT a CHANGE IN USE a GRADING
®RELOE'ATION g ®�'tA.1NiJFACTURED HOME
®SIGN }TENANT a OTHER
OWNER / APPLICANT INFORMATION
1
0 OWNER:44)[ At emir-f d_ 1G1Q _ a APPLICANT: / 2 44 7,V
PHONE:44 F--Z$'
Q _FAX: PHONE: Z/5--334, V FAX:
ADDRESS: 3 Z 3 S/ g.., t 4 Liov ADDRESS: 2-c - - /GZK.A,dc_f,e_J
® .' • 1/4.LLt CITY,STATE,ZIP � 2-CITY,STATE,ZIP
Y a 9
CONTRACTOR: £�f ( e $
ARCHITECT:
PHONE: .,q - 7 3 3 G FAX: PHONE: 9L-7- /2-6 FAX:9Z-7 - if,/
4oG.61t4 5 - 1‹.„k.p_____, ADDRESS: 3S dle Al• `C* ,ep.
eit4. aAtar. _ 1.1�" CITY,STATE,ZIP el tz•s 4,rCITY,S ATE,ZIP
WA ST CONTRACTOR LICENSE# iP /.J Z CONTACT: tUaJI gO2
IPERMIT/BUILDING INFORMATION
Il
COST OF PROJECT: — 30%SLOPES ON PROPERTY:
MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:
lZxif 2NoFLOOR5QFT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE:
UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY:
FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS:
GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE:
COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: 43 •
DECK:
REAR SETBACK: CURRENT SEPTIC USE: rQ`767t'" 1'4' 46 >Q/2._
b>s
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
IRELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
I 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 ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
IBUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO IF YES,WHICH WATER DiST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES 0 NO PSSA: 0 YES ® NO
IDATE: I STAFF: II
METHOD OF PAYMENT:
® 0 ® T i J_is VISA
CASH CHECK L.
BANKCARD#; EXPIRES: V/N#
AUTHOR/ZED SIGNATURE.' / X "y al---- 4v
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
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