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2003, 08-18 Permit App BLD-03-02258 MHValley Spam' e 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: —14 // 369 3 ,i i4c < SON ('c"`'� ASSESSOR'S TAX PARCEL NUMBER(S): 4/3-0 2 , 9io ti LEGAL DISCRIPTION: PERMIT DESCRIPTION: ® BUILDING PERMIT �] RELOCATION / T ge t= O CHANGE IN USE CI GRADING ® SIGN ® TENANT 112 MANUFACTURED HOME OTHER OWNER / APPLICANT INFORMATION ® OWNER: INC. A'UP I/t /KE',S` L.G G ® APPLICANT: n I Le- d446 E7 PHONE: 9Z(-`l3S I FAX:�t`�5 34i iD `t ' ' PHONE: 5.? 6Y91- FAX: 57 `f G' S ADDRESS: /7303 S/q-�=KSc J ADDRESS: /t'.TD`3 L'` J74-c=I<5ON -It-5 TC- CITY,STATE, ZIP 5794,k,4/IF w CITY, STATE, ZIP El CONTRACTOR: PHONE: . R(3 7 FAX: 0 ARCHITECT: PHONE: FAX: ADDRESS: Pt 6cyX 7S7 �.r� Pa_PK WI 006 ADDRESS: CITY,/STATE, ZI CITY, STATE, ZIP WA ST CONTRACTOR LICENSE # 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: 30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT: OCCUPANCY GROUP: 2ND FLOOR SQ FT: CONSTRUCTION TYPE: UNFIN BASEMENT: STRUCTURES ON PROPERTY: FINISHED BASEMENT: CRITICAL AREAS: GARAGE: CURRENT PROPERTY SIZE: COVERED DECK: CURRENT PROPERTY USE: DECK: CURRENT SEPTIC USE: CURRENT WELL USE: RIGHT SETBACK: IMPERVIOUS SURFACE AREA: MANUFACTURED HOME SIGN WIDTH: 7 YEAR: Qo 3 LENGTH: PIT SET: A/0 MANUFACTURER:__. G M A. 04 Oti'/1P ytifp�Up SQ FT OF SIGN: # OF SIGNS:_ TYPE OF SIGN: HEIGHT OF SIGN: AREA OF EXIST SIGN: RELOCATION FIRE SAFETY i i PREVIOUS ADDRESS: PROPOSED USE: FIRE SPRINKLER: PAINT BOOTH: FIREWORKS DISPLAY: BLASTING: FIRE ALARM: TENT: DATE/TIME: WA STATE NON-RESIDENTIAL ENERGY CODE PLANS EXAMINER: ADDRESS: PHONE: FAX: INSPECTOR: ADDRESS: PHONE: CITY, STATE, ZIP FAX: CITY, STATE, ZIP SPECIAL INSPECTIONS ® BOLTING °CONCRETE ® REINFORCEMENT ® WELDING FIRM NAME: PHONE: FAX: INSPECTOR(S): BUILDING STAFF USE ONLY IS PUBLIC SEWER AVAILABLE: --a-YES ® NO IF YES: COUNTY ® CITY IS PUBLIC WATER AVAILABLE: /YES 0 NO IF YES, WHICH WATER DIST/IRR: (A f//A/ IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: D YES ® NO IS THE PROPERTY LOCATED WITHIN ASA: YES 0 NO DATE: METHOD OF PAYMENT: PSSA: 0 YES ® NO STAFF: CASH CHECK VISA BANKCARD #; EXPIRES.' VIN # AUTHOR/ZED SIGNATURE. *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD