2003, 11-07 Permit App BLD-03-03023 MHNOV-06-2003 04:59 PM
INLAND HOME INSPECTION 509 534 6466
P. 02
doovealley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)6880038 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
/1Y
ASSESSOR'S TAX PARCEL NUMBER(8):
g.Sn 5'2 -. `J 52/ Al
LEGAL DIBCRIPTION:
PERMIT DESCRIPTION:
r'RUELDENG.PERMIT
ELOCATION
• ®CHANGE •USE • ®.GRADING
Q SIGN D TENANT
IONIANUFACTURED HOME
DOTHEB
p
i
OWNER / APPLICANT INFORMATION
..11111.Millmr
® OWNER: itf�14N I� �LL'rW4l L-2-�:. APPLICANT: �1`//' f
PHONE: c. li - 6 3 X FAX: Cl?y G IGG PHONE: FAX:
ADDRESS: if3.03' mil''C—K50)\{ 44.613' ADORES&
erPel f44'/ , 6014 99 20 6 CITY,BTATE, ZIP CITY, STATE, ZIP
Li CONTRACTOR' 21, ARCHITECT:
PHONE: FAX: $7 3`/ — 6. / 6'z. PHONE: FAX:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
NIAIMPIEMININIk
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:
SO% 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:
NOU 03 2003 17:08
PAGE.02
NOV-06-2005 04:59 PM INLAND HOME INSPECTION 509 534 6466
P_ 03
, r ,�
MANUFACTURED HOME�p
. SIGN
^
WIDTH; 02.�8 LENGTH: P
SQFTOFSIGN: HEIGHT OF SIGN:
%OF SIGNS: AREA OF EXIST SIGN:
YEAR* zer 3 PIT SET: NO
OF SIGN'
MANUFACTURER: MO YU-LUVE /ND(ASYRtETYPE
RELOCATION FIRE SAFETY
SPRINKLER: FIRE ALARM:
PREVIOUS ADORES
FIRE
�--onig
PAINT BOOTH: TENT'
/
_tine)
FIREWORKS DISPLAY:
PROPOSED USE'
BLASTING: DATE/TIME.
WA STATE NON-RESIDENTIAL ENERGY CODE I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
1
0 BOLTING
FIRM NAME'
INSPECTOR(S)•
OCONCRETE
0 REINFORCEMENT
0 WELDING
PHONE: FAX:
11
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 13 YES
IS PUBLIC WATER AVAILABLE: 0 YES ❑ N0
❑ NO
IF YES: ❑ COUNTY
0 CITY
IF YES, WHICH WATER DISTIIRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ❑ YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO
PSSA: ❑ YES 0 NO
1
' DATE:
1 STAFF:
METHOD OF PAYMENT::
0 ❑
CASH CHECK
BANKCARD# EXPIRES VINI
AUTHORIZED SIGNATURE:
"FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
0
NOV 03 2003 1?:09
PRGE.03