2003, 12-15 Permit App BLD-03-03280 ShopCITY OF
()3 39 Sly
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:
/OS )J £ FI RRF 1 0i?
ASSESSOR'S TAX NUMBER(S):PARCEL�+I Q sj e / 70 `(
LEGAL DISCRIPTION: 0 7 -j elk 3 / I / %: a 1." ! RV" Atli)
PERMIT DESCRIPTION:
RUILDLNG PERMIT
®RELOCATION
® CHANGE IN USE ® GRADING
0 SIGN ® TENANT
CI MANUFACTURED HOME
® OTHER
OWNER / APPLICANT INFORMATION
°OWNER: JA3oN C
PHON °e() 3 Z7 2963
ADDRESS: ,/05 2 2. 6
0 c el( d2•Z0 663 y _ s O. 1-1/1-1/4-,c4206
CONTRACTOR:
LUNQryl tf ® APPLICANT:
FAX: PHONE:
O
C ADDRESS:
,STATE, ZIP
PHONE: FAX:
ADDRESS:
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
ARCHITECT:
PHONE: FAX:
ADDRESS:
CONTACT:
CITY, STATE, ZIP
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:
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:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH:
YEAR:
MANUFACTURER:
LENGTH:
PIT SET:
SQ 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:
BLASTING:
FIRE ALARM:
TENT:
DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
i
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE ® REINFORCEMENT D WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: I YES ® NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: ® YES ElYESIF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: El YES ® NO PSSA: ® YES ® NO
DATE:
STAFF:
METHOD OF PAYMENT:
® 0 ® T 0
CASH CHECK
VISA
BANKCARD #; EXPIRES: VIN #
AUTHORIZED SIGNATURE -
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
E.;FffET oil
602 we )A c.c-E r 9 �
PLOT t y1051,
zowE Ui' 7
f. r‘Rg t5('
145 s tree t
•
•
pluv—JU—VVI 14 • J1 I KUI'I rtr 1 1 CL L I K 1 L Ul- v-ur,Hrit 1 V J3'4t3 'b7
11/30/01
14:07 ' 0509 324 3603
SP CT-Y REALM
FINAL AS-9UILT INSTALLATION
THT I CSCATiON OF NE Ot{I-St7E stesixR
Svt1 M UPPFS NTED SY THE OILNWRJC
IS N7' T;) AT CONSTRUED AS AN
sx &CT LOCA'ION Of THE SYSTEM
REMARKS (continued):
1 tv
NOV-30-2001 14 :17
509 324 3603
Post-tt" Fax Note 7671
Imre ii-30 -O s J esb f
'•°JIksCA) tAt&o )ARK
P.'" 31z1. b
CO/Cept
Ca
P""4I;a
�}/_!�
`2 /63
�) �✓/ry-�
a j31L ...I5OQ
Fall 6
- to LJ -L
tea, May -3403
96%
P.01
TOTAL P.01