2003, 08-18 Permit App BLD-03-02259 Set MHjValley
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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:
// 3a 3 E J .ct< SB/v
ASSESSOR'S TAX PARCEL NUMBER(S): </6-072 , 57C 1 z
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: 6'E7- (ooxe,
0 BUILDING PERMIT
QRELOCATION
a CHANGE IN USE 0 GRADING
C SIGN Q TENANT
)4: MANUFACTURED HOME
®-OTHER
OWNER / APPLICANT INFORMATION
® OWNER: /NL, A/JD 1fDfr 1 G c
PHONE: 92.(—` "SS7 FAX: 5-3 / i0 ci66,
ce(l S-
CITY ,STATE, ZIP
ADDRESS: //303' C
°CONTRACTOR: /11 R,
PHONE: 276 - g f ? FAX:
ADDRESS: 1 f' &' x 7s7 r.7", ne^ Park((� friOaC ADDRESS:
CITY/STATE, ZI P7
APPLICANT: fn / LC ,milli 'E7
,r7?�
PHONE: (39f FAX: 53 ` (s404.
ADDRESS: /(3 ' E (mk 15 A7 -4r5ir
-5-/Oag w 14 CITY, STATE, ZIP
ARCHITECT:
WA ST CONTRACTOR LICENSE #
PHONE:
CONTACT:
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:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: 2 7
YEAR: 003
LENGTH:
PIT SET:
/JCl
MANUFACTURER: 0 07u NC
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: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
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: COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: YES El NO IF YES, WHICH WATER DISTIIRR: R V t /•/1
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO
PSSA: 0 YES ® NO
DATE: I STAFF:
METHOD OF PAYMENT:
CASH CHECK
VISA
BANKCARD #; EXPIRES: VIN #
AUTHOR/ZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD