2003, 05-19 Permit App: BLD-03-0463 Reroof, Reside• "
City of
SPOKANE VALLEY
622- 003 Cp
Fa,/ 0-37
PERMIT # BD b3 -
B 1 DING PERMIT APPLICATION
Box -1 OWNER S LJ/ "4v15 JOB LOCATION N.
' 693
OWNER'S ADDRESS 51r7ng- CITY --A,)t ,WPHONE g5\y-3 a Sa -
DESCRIBE JOB-<�j,(7
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED 5-/A)6(--4-
PARTNERSHIP
/A)GL-XPARTNERSHIP CORP.
30X 2 CONTRACTOR'S NAME
PHONE
CONTRACTOR'S ADDRESS
CONTRACTORS REG.#
CITY
EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VEFFIED)
30X 3 CONTACT PERSON OF PROJ
CT P9/; PHONE
ADDRESS , CITY ZIP
lOX 4 SEWER AVAILABILITY WATER AVAILABILITY
1OX 5 ESTIMATED PROJECT COST
asn
,OX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
EXISTING BLDG. VALUATION $ 60Ad5
..a
(IF NECESSARY, PLEASE SUB IT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) ;,
i
- CENSUS NUMBER
LOT NUMBER
DX 7 BUILDING SQUARE FOOTAG
/ proposed)
3RD FLOOR / OTHER
1ST FLOOR / 2ND FLOOR /
/ BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK
CARPORT / TOTAL /
( ) MULTIFAMILY (NO. OF UN TS
( ). COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
)X8
SINGLE FAMILY
/ GARAGE
HEIGHT TO PEAK OF BUILDING FT,
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY F SQ. FT.
IMPERVIOUS SURFACE SQ. FT.
)X 9 PLUMBING FIXTURES (Includingl.rough-Ins) MECHANICAL APPLIANCES
PLEASE USE THE ATTACHED PLUMBING / MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SYSTEMS, HEATING AND AIR UNITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS,
LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL.
IX 10 Water Service meter size f known)
Also see BOX 4
X 11 Septic Tank - Not generally allowed in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor and te Health District (See BOX 4)
X 12 Street use may require a "
Works Department.
treet Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
ERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND •
RRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
JVE PREMISES • PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE_
NER I AGENT �!�� g'".15' nATP c 1 J� 3
/r\\ /C6\
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard � Expiration Date
Print the name of the Folder Signature
OFFICE USE ONLY - PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS:FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
SEPA: EXEMPT • NOT EXEMPT
FIRE DEPARTMENIiPROVAL DISAPPROVAL DATE
REMARKS
PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ALT/ADD NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORIES
i BUILDING SQ. FT. @ =
BUILDING SQ. FT. @
BUILDING SQ. FT. @ —
BUILDING SQ. FT. @ —
TOTAL SQ. FT.
TOTAL VALUATION
BUILDING PERMIT NO. /'1 L' 3 PLAN CHECK FEE REC'D RECEIPT NUMBER
PERMIT FEE 3 %1.?---G---PLAN CHECK FEE / {�.C, 5 PLUMBING FEE MECH. FEE
TOTAL FEES WSBCC SURCHARGE -4,s--c--) ENERGY SURCHARGE
OTHER CHARGES AMOUNT DUE i O1+'
BUILDING DEPARTM NT APPROVAL BY
DATE 5 ",�
402--
ASSIGNED
'dam
ASSIGNED ADDRESS
City of SPOKANE VALLEY
Building,
Applicant/Business
Fire and Public Works Fees Receipt 003., 1,143
Permit No.
Date / -
Project Name
Site Address 40 Z 10 .
Please Receipt the Following:
= a =
= = = =
Check Number 4.7 7 5 Receipt Number
Payer's Name kA) t.f.-1 Ja A
Address City Zip
BUILDING DEPARTMENT
001.059.322.10.01
001.059.322.10.02
001.059.322.10.03
001.059.321,10.04
001-.059.322.10:06
001.059.322.90.01
001.059.345.83.01
001.059.345.83.03
001.059.342.40.02
'001.059.237.10.98
001.059.237.10.02
FIRE DEPARTMENT #
001.059.322,10.07
001.059.322.10.08
001.059.322.10.09
001.059.322.10.10
001.059.322.10.11
001.059.322.10.12
001.059.322.10.13
001.059.321.30.00
001.059.342.40.01
001.059.237.10.99
OTHER:
Building Permit
Plumbing Permit
Grading Permit
Mechanical Permit
Demolition Permit
Misc. Permits and Fees
Plans Check Fee
Energy plans check fee
SPECIAL Inspections
Bonds / Deposits
WSBCC Surcharge *
Pians check fee
Sprinkler plans check
F. A. Plans checK
Misc. plans check
Fire Alarm inspections
Sprinkler inspections
Misc. Inspections
Fireworks Permit
UFC permit fees
Bonds / Deposit
**
$
r
PUBLIC WORKS
001.059.322.40.00 Right of Way
001.059.342.40.03 Special Inspections
001.059.237.10.99 Bonds/Deposits (cash)**
TOTAL AMOUNT DUE
S
S
S Lin1'
0
s.
* To be sent to Wash. State Building Code Council quarterly.
# 65% of figure to be sent to the Fire Department Quarterly, except bonds etc.
* * Liability Insurance verification may also be required.
S-vrG pt