2003, 08-28 Permit App BLD-03-02345 MH°°°;‘'a
.„.0Valley
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:
ASSESSOR'S TAX PARCEL MBER(S):
LEGAL DISCRIPTION: lite
PERMIT DESCRIPTION: %4• •1-1
D BUILDING PERMIT
El -RELOCATION
it 144 Hi,/
a CHANGE IN USE 0 GRADING
®-SIGN Q] TENANT
x TO
4MANUFACTURED HOME
Q-OTHER
® OWNER:
PHONE: gZ3
ADDRESS:`aBCG
®CONTRACTOR:
PHONE: fa-
70193 FAX: O7,'-f3iJ
ADDRESS:
OWNER / APPLICANT INFORMATION
FAX:
CITY,STATE, Z
trtze6
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # G(//'YwP4,5
APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
ARCHITECT:
PHONE: FAX:
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:
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
OCCUPANCY GROUP 2ND 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: LENGTH:
YEAR: / 7� PIT SET.
MANUFACTURER:
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:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING ❑ CONCRETE ® REINFORCEMENT ❑ WELDING
FIRM NAME:
INSPECTOR(S):
PHONE: FAX:
BUILDING STAFF USE ONLY
i
IS PUBLIC SEWER AVAILABLE: ® YES ❑ NO
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO
IF YES: ® COUNTY
❑ CITY
IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ❑ YES ❑ NO
IS THE PROPERTY LOCATED WITHIN ASA: ❑ YES ❑ NO PSSA: ❑ YES ❑ NO
DATE:
METHOD OF PAYMENT:
0
CASH
I
STAFF:
❑ ❑
CHECK
0
BANKCARD #; EXPIRES:
AUTHORIZED SIGNATURE:
VIN#
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD