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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