2003, 11-07 Permit App BLD-03-03025NOV-06-2003 05:00 PM
INLAND HOME INSPECTION
509 534 6466 P_04
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:
( 3
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISORIPTION:
L.-rMci<SoN 5"
51"5-0 V2.96 /1
PERMIT DESCRIPTION:
jiliTIELDDTG.PERMIT ❑ CHANGE .D I USE • D GRADING
RELOCATION D SIGN D -TENANT
MANUFACTURED HOME
IDOTHER
J
OWNER / APPLICANT INFORMATION
OWNER: /I S,- l P te-11 �*ZC 0
PHONE: SXy 639e FAX: ::? � 7
ADDRESS: U-F003b ,T CKSO�t1 #Sr�
0+;q0eAt. -' via CITY,STATE, ZIP
CONTRACTOR: ` G�
APPLICANT: <3/0,P4
PHONE:
ADDRESS:
FAX
OITY, STATE, ZIP
ARCHITECT:
PHONE FAX: PHONE: FAX
ADDRESS: ADDRESS:
CITY, STATE, ZIP
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE 0 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:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNPIN BASEMENT -
FINISHED BASEMENT:
GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
NOU 03 2003 17:09
PAGE.O4
NOV-06-2003 05:00 PM INLAND HOME INSPECTION
509 534 6466 P.05
MANUFACTURED HOME
SIGN
WIDTH: 7 LENGTH: AR
YEAR: lace PIT SET: AnD
MANUFACTURER: 6-u.E-f 3,o4
SO FT OF SIGN: HEIGHT OF SIGN:
it OF SIGNS. AREA OF EXIST SIGN:
TYPE OF SIGN.
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS:
.NietV
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
I� SPECIAL INSPECTIONS
1
❑ BOLTING
°CONCRETE
❑ REINFORCEMENT
❑ WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
1
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ❑ YES ❑ NO
IS PUBLIC WATER AVAILABLE: • YES ▪ NO
IF YES: ❑ COUNTY CITY
IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ❑ YES CI NO
IS THE PROPERTY LOCATED WITHIN ASA: ❑ YES ® NO PSSA: Q YES ❑ NO
DATE:
I STAFF:
1
METHOD OF PAYMENT;
❑
CASH CHECK
0
VISA
BANKCARD# EXPIRES. VINO
AUTHORIZED S/ONATURt
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
NOU 03 2003 17:10
PAGE.05