2003, 09-23 Permit App BLD-03-025590
00NTRACTOR: - 5/9742
PHONE:
ADDRESS:
j�
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: [ ( 5O (=
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
574 cK So e41 4602 6
PERMIT DESCRIPTION: //1.1,ut"�=i4 D �(avl1L SET
BUILDING PERMIT
[RELOCATION
O CHANGE IN USE ® GRADING
Q SIGN TENANT
MANUFACTURED HOME
E OTHER
OWNER / APPLICANT INFORMATION
a OWNER: W /LL/61 Ems! 1�
PHONE: 5 ,?y-(e 3 9 P FAX: 5-3Y -6 ',G"‘
ADDRESS: // 30TA-C_'( .S61,0 S`g
oogAN� t,,irJ gtTY,STATE,ZIP
® ARCHITECT:
FAX: PHONE: FAX:
ADDRESS:
a APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
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:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
DECK:
MANUFACTURED HOME SIGN
WIDTH:
LENGTH:
YEAR:PIT SET:
CC." •/
MANUFACTURER:
i-t" 0- 1,4-1 tJ to A)
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 0 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 DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES 0 NO PSSA: ® YES ® NO
DATE:
i
METHOD OF PAYMENT.
STAFF:
® -°
CASH CCHECK j
BANKCARD #;
AUTHORIZED SIGNATURE.
0
VISA
EXPIRES: VIN #
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD