2003, 08-18 Permit App BLD-03-02258 MHValley
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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
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