The URL can be used to link to this page

2004, 01-30 Permit App BLD-04-03475 Place MH*Wane 3(0 5 PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUNITYDEVELOPMEN 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 NUMBER(S): LEGAL DISCRIPTION: PERMIT DESCRIPTION: 34)A. p X r i f1 ck Kr) j-1 c9 N BUILDING PERMIT CHANGE IN USE CI GRADING Q RELOCATION Er SIGN TENANT i I`P.�J c�SQ r IA) OdaL1DP NUFACTURED HOME OTHER OWNER / APPLICANT INFORMATION f ® OWNER: /" / / 0 de ADDRESS23�O zn / /L /-4,,-4 %%D// CITY, TATE, ZIP APPLICANT: SHONE: 3q/- 5 $� 8 5 5 62 y3�n FAX: 4 / ^ PHONE: FAX: �S ADDRESS: • c S Va f /kr-4/-/�-f� > 9 20(.o ADDRESS: CI ,STATE, ZIP ®CONTRACTOR: ( Z. , O/21h (9OI C/ ARCHITECT: PHONE:569(9') 292ne FAX: PHONE: ADDRESS: CITY, STATE, ZIP FAX: CITY, STATE, ZIP WA ST CONTRACTOR LICENSE # , 90k.,02 979 1'9 CONTACT: Px49. /o/z9/Zoo5- PERMIT/BUILDING INFORMATION COST OF PROJECT: ` 1� BUILDING HEIGHT TO PEAK: 1` BUILDING DIMENSIONS: 1C yv NUMBER OF STORIES: NUMBER of BEDROOMS: FLANKING SETBACK: _ 1-: FRONT SETBACK: J REAR SETBACK: Co 0 I LEFT SETBACK: a a , Co RIGHT SETBACK: �J 30% SLOPES ON PROPERTY: OCCUPANCY GROUP: CONSTRUCTION TYPE: STRUCTURES ON PROPERTY: CRITICAL AREAS: CURRENT PROPERTY SIZE: / 37)A. /0(0' CURRENT PROPERTY USE: %ARENT OPTIC USE: CURRENT WELL USE: IMPERVIOUS SURFACE AREA: MAIN FLOOR SQ FT: 2ND FLOOR SQ FT: UNFIN BASEMENT: FINISHED BASEMENT: GARAGE: COVERED DECK: DECK: MANUFACTURED HOME SIGN WIDTH: 7 LENGTH: VL% YEAR: O / PIT SET: j MANUFACTURER: //�Pe)4eilic 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 FIRM NAME: INSPECTOR(S): ®CONCRETE ® REINFORCEMENT PHONE: CI WELDING FAX: BUILDING STAFF USE ONLY IS PUBLIC SEWER AVAILABLE: ® YES CI 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 ® NO IS THE PROPERTY LOCATED WITHIN ASA: ® YES CI NO PSSA: ® YES ® NO 11 DATE: STAFF: 1 METHOD OF PAYMENT.- CASH CHECK BANKCAR AUTHORIZED SIGNATURE:: c 1 t' k VISA EXPIRES: VIN # *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD i Siriokat' ne 40.0Valley STREET ADDRESS: PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUN/TY DEVELOPMENT BUILDING DIVISION 91707 East Sprague Ave Ste 106 Spokane Valley, WA 99206 Phone: (509)688-0036 Fax: (509)688-0037 REQUIRED SITE INFORMATION /0 5-o 6- it ' # 6) ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: PERMIT DESCRIPTION: u n c' -E> d Eo o rn e r) (Ara-P r al 14 V BUILDING PERMIT 0_CHANGE IN USE 0 GRADING (RELOCATION c-SIGN C TENANT .0.ANUFACTURED HOME CI OTHER • - OWNER / APPLICANT INFORMATION ®OWNER: /1�; I 0 pCer PHONE:[00-taa(0 (-13,:)S °FAX: - 34 I -5 ADDRESS: S • L(D.. 0 et() Metriei- OC.I i • f/ j CITY, ST,QTE,, ZI P ® El CONTRACTOR:(( L �I� ► t 0Q w�. ID Co ICC�iS�` [[ 4-- ARCHITECT: PHONE6o Q' 1 Y) - 7 7 ©0 FAX: PHONE: FAX: ADDRESS: 2)J - '4 a r t�� br^ ADDRESS. L' ic>._Q r -' 1 c O 1 OI CITY, STATE, ZIP WA ST CONTRACTOR LICENSE # h L h7 h kV) L Th q 74 J CONTACT: fix. \ 0 I?_01 ibS APPLICANT: PHONE: FAX: ADDRESS: CITY, STATE, ZIP CITY, STATE, ZIP PERMIT/BUILDING INFORMATION COST OF PROJECT: i 50 U BUILDING HEIGHT TO PEAK: BUILDING DIMENSIONS: X L10 NUMBER OF STORIES: NUMBER of BEDROOMS: FLANKING SETBACK: FRONT SETBACK: i 5 REAR SETBACK: LEFT SETBACK: RIGHT SETBACK: 33 (0 30% SLOPES ON PROPERTY: OCCUPANCY GROUP: CONSTRUCTION TYPE:(Or\en.L/ ) STRUCTURES ON PROPERTY: CRITICAL AREAS: CURRENT PROPERTY SIZE: (59 /00, CURRENT PROPERTY USE: �S CURRENT SEPTIC USE: CURRENT WELL USE: IMPERVIOUS SURFACE AREA: MAIN FLOOR SQ FT: 2ND FLOOR SQ FT: UNFIN BASEMENT: X FINISHED BASEMENT: GARAGE: COVERED DECK: DECK: MANUFACTURED HOME SIGN WIDTH: LENGTH: YEAR: 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: PHONE: FAX: ADDRESS: CITY, STATE, ZIP INSPECTOR: PHONE: FAX: ADDRESS: CITY, STATE, ZIP SPECIAL INSPECTIONS ® BOLTING ®CONCRETE ® REINFORCEMENT FIRM NAME: INSPECTOR(S): PHONE: ® WELDING FAX: BUILDING STAFF USE ONLY IS PUBLIC SEWER AVAILABLE: CI YES ® NO IS PUBLIC WATER AVAILABLE: YES NO IF YES: ICICOUNTY 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: 0 YES ® NO DATE: 1 STAFF: METHOD OF PAYMENT.' CASH CHECK BANKCARD #; EXPIRES: VIN # AUTHORIZED SIGNATURE.• *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD 'flWG ._.1 n' sjanw&1 r :G C YO ran ars 31P 5I� PLAN _ OPI- - RESIDjC sent.,E 1/16 -1:a" PLANNING DEPT. APPROVED BY; DATE IQ"D1-- Z5 yew& t--- r-�rrrcrt�-- GATE