2005, 01-14 Permit App 05000137 MHsdfe\'`
cD5-- 0/37
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVIS/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206....
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 1/3 03 !r • N j 74 el< g QA1 2?
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
4/5-09z. Y6 1 9(P(7j
PERMIT DESCRIPTION:
CI 'WILDING.PERM T -• 0 CHANGE IN USE II.GRADING
EIRELOCATION El-SIGNE TENANT
COMANUFACTURED _$
I HR
®CONTRACTOR: �.Q,y`� ® ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,. STATE, ZIP
OWNER / APPLICANT INFORMATION
® OWNER: LX/L wD itie ^f &-S , C[® APPLICANT:
PHONE: 9 / f 57 FAX: J j �p �p PHONE:
ADDRESS: // ?O-3 CfGsGr(1 Ste" ADDRESS:
S�pf�ycQ i%,QQa„ 41,04 99
20 ,STATE, ZIP
FAX:
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
CITY, STATE, ZIP
CONTACT:
COST OF PROJECT:
PERMIT/BUILDING INFORMATION
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:
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:
IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: 2 3 LENGTH: 5,-2 D SQ FT OF SIGN: HEIGHT Or SIGN:
YEAR: 65— PIT SET: . /t/' # OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: C-W A-vi/ idC 0/11 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:
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
®CONCRETE
CITY, STATE, ZIP
® REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER. AVAILABLE: ® YES • NO
IS PUBLIC WATER AVAILABLE: 0 YES NO
IF YES: 0 COUNTY CITY
IF. YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: CI YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO PSSA: ® YES 0 NO
DATE:
11,
METHOD OF PAYMENT:
I STAFF:
O ® 0
CASH . CHECK
BANKCARD #; EXPIRES: V/N#
AUTHORIZED SIGNATURE
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD