2003, 10-28 Permit App BLD-03-02917 Lean-ToSTREET ADDRESS:
65- 2V
la
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 Fast Sprague Ave Ste 106
Spokane Valley, WA 99206.
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: e /? N re)
gRIJILDING.PERMIT .
RELOCATION
CI CHANGE IN USE Ci GRADING
®-SIGN Q TENANT
CI MANUFACTURED HOME
DO FILER
OWNER / APPLICANT INFORMATION
® OWNER: /I/ /IA/ j /tl / fit ® APPLICANT:
PHON S °`t '-// 17 FAX:
PHONE:
FAX:
ADDRESS: 4/ 7(9 6 (,, K I) 0 (, ADDRESS:
® CITY,STATE, ZIP
CONTRACTOR:
PHONE:
ADDRESS:
FAX:
WA ST CONTRACTOR LICENSE #
COST OF PROJECT:
CITY,.STATE, ZIP
CITY, STATE, ZIP
ARCHITECT:
PHONE: FAX:
ADDRESS:
CONTACT:
PERMIT/BUILDING INFORMATION
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 SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
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:
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
0 BOLTING ®CONCRETE
FIRM NAME:
INSPECTOR(S):
® REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO
IS PUBLIC WATER AVAILABLE: YES NO
IF YES: COUNTY CICITY
IF. YES, WHICH WATER DISTIIRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: El YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 0 YES ® NO
METHOD OF PAYMENT:
C 0
CASH CHECK
VISA
sminim
BANKCARD # EXPIRES: VIN #
AUTHORIZED SIGNATURE*
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
10/28/2003 12:31 FAX 509 477 4703 SPOKANE CO BLDG.
L
Ler /
COOK BROTHERS CONTRACTING ,
Route 2 Box 853 B
OTIS ORCHARDS, WA 99027
(509) 924-1557
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OCT 25 2003 13:34
509 477 4703
PAGE.131
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