2003, 08-18 Permit App BLD-03-02261 MH$61iale\'`
4.00Valley
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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
i
['RELOCATION.
STREET ADDRESS:
REQUIRED SITE INFORMATION
3v 3 J >4c SCA/
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
f607 2 ye'
0 )-
PERMIT DESCRIPTION: SET g ovue-
El BUILDING PERMIT $CHANGE IN USE a GRADING
iI-SIGN TENANT
Ar,INIANUFACTURED
Q-4J B ±R
OWNER / APPLICANT INFORMATION
® OWNER: //VL,i4/UD
PHONE: 92(--q .S % FAX: 5--.3y
ADDRESS: /r/'D3 C ,711-c<sc (J
CITY,STATE, ZIP
®CONTRACTOR: f 1 g-
PHONE: , 8 ( 3 FAX:
ADDRESS: P25 'Orx 75-7 P (,4 90)0C
CITY/STATE, ZI
WA ST CONTRACTOR LICENSE #
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APPLICANT: c7 / LL 6 ��C 7
PHONE: 5 6..r9?"
ADDRESS: /i.'U"
ARCHITECT:
PHONE:
FAX: 53,-i &/4#4o
J7 -G/CS 4rCir
92ZZ� CITY, STATE, ZIP
FAX:
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:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
STRUCTURES ON PROPERTY: • FINISHED BASEMENT:
GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
CRITICAL AREAS:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: 27
YEAR: aOD
LENGTH: 3
PIT SET: /LIO
MANUFACTURER: M 0' 4-iti
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: PHONE: FAX:
ADDRESS:.
INSPECTOR:
ADDRESS:
.. - CITY, STATE, ZIP
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING
FIRM NAME:
INSPECTOR(S):
® CONCRETE
0 REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: MYES ® NO
IS PUBLIC WATER AVAILABLE: YES ® NO
IF YES: • COUNTY ® CITY
IF. YES, WHICH WATER DIST/IRR: 1R11//
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: • YES NO
f DATE:
PSSA: CI YES ® NO
1
METHOD OFPAYMENT:
® 0
CASH CHECK
STAFF:
BANKCARO#; EXPIRES: VIN#
AUTHOR/ZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD