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2005, 01-14 Permit App 05000136 MHPERMIT 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: /1363 Et T4 so/ S3 ASSESSOR'S TAX PARCEL NUMBER(S): c/ ,99 2 .5-=? LEGAL DISCRIPTION: PERMIT DESCRIPTION: . •CIBINIDDING•PE T • Et RELOCATION • D CBANGE •IN.USE • •Ci•GRAI)ING -SIGN ]-TENANT FACTURED HOME i OWNER / APPLICANT INFORMATION OWNER:_ /U2%4 /UI) - / (76W S) ® APPLICANT: S-/1 L --=- PHONE:_ 927 9 S.7, 7- L/ I FAX:6 7 C9 ADDRESS: // 74 3 JA-CJ<9 / S- ADDRESS: S�%Oie A f .yhTY,STATE, ZIP CONTRACTOR: 5 4l/le lj ARCHITECT: PHONE: FAX: PHONE: FAX: PHONE: CITY, STATE, ZIP FAX: ADDRESS: ADDRESS: CITY,. STATE, ZIP WA ST CONTRACTOR LICENSE # 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: CRITICAL AREAS: GARAGE: CURRENT PROPERTY SIZE: COVERED DECK: CURRENT PROPERTY USE: DECK: CURRENT SEPTIC USE: CURRENT WELL USE: RIGHT SETBACK: IMPERVIOUS SURFACE AREA: MANUFACTURED HOME SIGN WIDTH: 2. LENGTH: 2 YEAR: �O�i S PIT SET: N MANUFACTURER: G}-( -mil. P I ©AS 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: 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: ® YES NO IF YES: ® COUNTY 0 CICITY IS PUBLIC WATER AVAILABLE: ® YES 0 NO IF. YES, WHICH WATER DIST/IRR: IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO • PSSA: 0 YES ® NO DATE: METHOD OF PAYMENT.- 1 CASH CHECK STAFF: BANKCARD#; EXPIRES:: VIN# AUTHORIZED SIGNATURE: ‘/01A7 *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD