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2005, 01-14 Permit App 05000138 MH•/\... 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: //S Q, ATRCK,S ©A/ ASSESSOR'S TAX PARCEL NUMBER(S): 9S O 7 2, 9 G VP' Ai LEGAL DISCRIPTION: PERMIT DESCRIPTION: a BUILDING PERMIT - CI CHANGE IN USE • C.GRADING ®SiG1�I ®-TENANT El -RELOCATION MANUFACTTT1tED Et OWNER / APPLICANT INFORMATION OWNER:_ %ice r444 - L e ADDRESS: /( 03 JWCi<s oKJ 0 U',, CITY,STATE, ZIP .. - CON RACTOR:2d.6 � ARCHITECT: �} El APPLICANT- z L PHONE: 9,2/- 9 3,S^/ FAX: 5j 3 - PHONE: FAX: ADDRESS: PHONE: ADDRESS: FAX: CITY,.STATE, ZIP WA ST CONTRACTOR LICENSE # PHONE: FAX: CITY, STATE, ZIP 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: RIGHT SETBACK: .111111111, 30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT: OCCUPANCY GROUP: 2No FLOOR SQ FT: CONSTRUCTION TYPE: 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: :2.6 g. YEAR: 2065- LENGTH: 5:2 �- PIT SET: MD MANUFACTURER: C- 4/4 G1-10I.C),(J 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: PAINT BOOTH: FIREWORKS DISPLAY: FIRE ALARM: TENT: BLASTING: DATEITIME: WA STATE NON-RESIDENTIAL ENERGY CODE PLANS EXAMINER: PHONE: FAX: ADDRESS:. 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: 13 YES 13 NO IF YES: © COUNTY 0 CITY - IS PUBLIC WATER AVAILABLE: ❑ YES CINO 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: 0 YES 0 NO i DATE: STAFF: METHOD OF PAYMENT: ® ® O CASH CHECK BANKCARD//; EXPIRES:' V/N# AUTHORIZED SIGNATURE. *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD