2004, 09-01 Permit App BLD-04-07543 MH Set40.0Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
91707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: / / 30 50Ai "
ASSESSOR'S TAX PARCEL NUMBER(S): eiS-O 9z - 9C e/ ill
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: ,'M/Uvt FA c-7 U Alod1,6 SEA
BUILDING PERMIT
®RELOCATION
® CHANGE IN USE ® GRADING
® SIGN Q TENANT
$MANUFACTURED HOME
0 OTHER
I OWNER / APPLICANT INFORMATION
® OWNER: /( fLG/aCLi
PHONE: 53Y--6 392'
ADDRESS: //,?O 3 &
®CONTRACTOR: $Am' E
4Et 7 J4// / ® APPLICANT:
c/
FAX: �7-�0 3 S PHONE: 1 FAX:
7-AiGi<SIVA/ ADDRESS:
CITY,STATE, ZIP
SAME
PHONE: ) FAX:
ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
03
ARCHITECT:
PHONE:
ADDRESS:
CONTACT:
i
CITY, STATE, ZIP
FAX:
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: 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: v7-
YEAR: 2 D0 1
LENGTH:
PIT SET: L)
MANUFACTURER: 4-.D17I.3 6,0 5.7-
SQ FT OF SIGN:
# OF SIGNS:
TYPE OF SIGN:
HEIGHT OF SIGN:
AREA OF EXIST 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
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: ® YES 0
NO IF YES, WHICH WATER DISTIRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO
DATE:
METHOD OF PAYMENT:
PSSA: ® YES ® NO
STAFF:
0
0 T'
0
tit1{KkYt!
CASH CHECK
VISA
BANKCARD EXPIRES: VIN #
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD