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2003, 08-18 Permit App BLD-03-02260 MHscoierne jValles STREET ADDRESS: i13o 3 O»224O 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 ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: ,1 i4c1k SBN (0i3 PERMIT DESCRIPTION:'ET a BUILDING PERMIT URELOCATION CI CHANGE IN USE CI GRADING ACTURED .HOME ®-SIGN D TENANT ®-OTHER... OWNER / APPLICANT INFORMATION ® OWNER: /NZ,AA/ P //e/yt -s' �� GEl APPLICANT: nI LC.- 6I63A-.- PHONE: / FAX: $ 311 ci6 •PHONE: ?y 6'qer ADDRESS: 3O� C SI�K�I FAX: S.�`{� (v��j(p # ADDRESS: /(3 3 E �j -GKS OA7 S`ir "d"44" ; LU,4 92Za6 CITY, STATE, ZIP ARCHITis PHONE: CONTRACTOR: ADDRESS: P -- 6 WA ST CONTRACTOR LICENSE # FAX: CITY,STATE, ZIP p. ( 7 CITY,. STATE, ZI FAX: OU6 ADDRESS: CITY, STATE, ZIP 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: 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: MAIN FLOOR SQ FT: 2ND FLOOR SQ FT: UNFIN BASEMENT: FINISHED BASEMENT: GARAGE: COVERED DECK: DECK: MANUFACTURED HOME . SIGN SQ FT OF SIGN: HEIGHT OF SIGN: WIDTH: LENGTH: ,.:"7 Co H N C # OF SIGNS: AREA OF EXIST SIGN: YEAR: .Z PIT SET: C- HA-04 e(©pCf TYPE OF SIGN: MANUFACTURER: j/i~iv. RELOCATION FIRE SAFETY FIRE SPRINKLER: FIRE ALARM: PREVIOUS ADDRESS: PAINT BOOTH: TENT: FIREWORKS DISPLAY: PROPOSED USE: BLASTING: 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: INSPECTOR(S): PHONE: FAX: BUILDING STAFF USE ONLY IS PUBLIC SEWER AVAILABLE: *YES ❑ NO IS PUBLIC WATER AVAILABLE: ` YES 0 NO IF YES: ❑ COUNTY ❑ CITY - IF YES, WHICH WATER DISTIIRR: 7R11//N/ IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO IS THE PROPERTY LOCATED WITHIN ASA: ❑ YES 0 NO PSSA: ❑ YES 0 NO DATE: 1 METHOD OF PAYMENT: ❑ 0 CASH CHECK STAFF: 0 VISA BANKCARD#; EXPIRES: VIN# AUTHORIZED SIGNATURE: *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD 1