2003, 09-23 Permit App BLD-03-02556 Set MH4,00Valley
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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 Gf< SCEAl `4 it
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: /1464,(/£t 'TZc/2. -p 44E—
® BUILDING PERMIT
I] RELOCATION
® CHANGE EN USE
D SIGN
® GRADING
® TENANT
T
ANUFACTUR.ED HOME
1 OTHER
OWNER / APPLICANT INFORMATION
OWNER: LA / LG�If}N-C
PHONE: .> 3y-6 39V--
ADDRESS: //703 E,
5A,I<A
CONTRACTOR: S'9E
PHONE:
�- APPLICANT: 57.0Y1"L�i
FAX: 3y PHONE: FAX:
C 5OJ1 S-� ADDRESS:
9924E CITY,STATE, ZIP CITY, STATE, ZIP
CI
ARCHITECT:
FAX: PHONE: FAX:
ADDRESS:
ADDRESS:
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
CONTACT:
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:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
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
7-WIDTH: ,,Z S
YEAR: ° c' 2
\ MANUFACTURER:
LENGTH: -5 C
PIT SET: /1 /A
SQ FT OF SIGN:
# OF SIGNS:
TYPE OF SIGN:
HEIGHT OF SIGN:
AREA OF EXIST SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: /` :/f
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:
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: ® COUNTY Ir3 CITY
IS PUBLIC WATER AVAILABLE: YES NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: YES NO
PSSA: ® YES ® NO
DATE:
STAFF:
METHOD OF PAYMENT;
WSA
BANKCARD #; EXPIRES: VIN #
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD