2003, 09-23 Permit App BLD-03-02557 Set MH0
Spolane
jvalley
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: (5091688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 7/76 3 L
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: iM 4Alb=frv-c--(t 7)
CIBUILDING.PERMrr
QRELOCATION
CCHANGE IN USE ID GRADING gMMANUFACTURED HOME
OTRER
la SIGN 0-TENANT
OWNER / APPLICANT INFORMATION
® OWNER: Grl/GG/,4 6 1 &-F&X
PHONE: S7Y 6 7791 FAX: S34/ ' ci2
ADDRESS: /1/j03 Cc Cri+CtC Sae
S�61001&; CITY,STATE, ZIP
CONTRACTOR: �',4vH�C CI ARCHITECT:
PHONE: FAX: PHONE:
ADDRESS: ADDRESS:
CITY,. STATE, ZIP
WA ST CONTRACTOR LICENSE # CONTACT:
APPLICANT: 5714-0-/c
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
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: g- LENGTH: F' / a
YEAR: ,ZOO Z PIT SET: ///49
MANUFACTURER: r/-f/ t P,c s,/
SQFTOFSIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS: /(/7
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 El NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: "' CI YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 0 YES ® NO
DATE:
1
STAFF:
METHOD OFP. MENT:
® CASH CHECK
Ill'(
VISA
BANKCARD#; EXPIRES: VIN#
AUTHOR/ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD