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2003, 05-05 Permit App: BD03-333 Garage
City ©f SPOKANE VALLEY PERMIT # BUILDING PERMIT APPLICATION Box 1 OWNER A LL.Ls-) ✓} 4, AJOLAD JOB LOCATION ( (, uc! OWNER'S ADDRESS CITY PHONE DESCRIBE JOB 9k f ( a✓I �Y'-� THIS PROPERTY IS OWNED BY: SINGLE/MARRIED bC PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME (1 Le_ Oc_.r) PHONE 3 2 c.) • L! ? Si CONTRACTOR'S ADDRESS / 8 L{ o y 1/)._ ii i) J CITY G 2 u z ✓lc' r2_Ls C CONTRACTOR'S REG.# EXPIRATION DATE (CARD MUST BE PRESENTED AND COPIED OR VERIFIED) BOX 3 CONTACT PERSON OF PROJECT A L. L PHONE 3 70-'4 7< ADDRESS g U Li //2 8o r-) CITY bevGA- ZIP 7 v/ BOX 4 SEWER AVAILABILITY WATER AVAILABILITY BOX 5 ESTIMATED PROJECT COST $ EXISTING BLDG. VALUATION $ BOX 6 PROPERTY TAX ACCOUNT NUMBER 65! 9 Y /I LEGAL DESCRIPTION (IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) CENSUS NUMBER LOT NUMBER BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR 3RD FLOOR / OTHER BASEMENT UNFINISHED / DECK CARPORT / TOTAL / 2ND FLOOR BASEMENT FINISHED / GARAGE / 1 HEIGHT TO PEAK OF BUILDING FT. BOX 8 ( ) SINGLE FAMILY ( ) MULTIFAMILY (NO. OF UNITS ( ) COMMERCIAL / INDUSTRIAL ( ) TENANT IMPROVEMENT ( ) NEW CONSTRUCTION ( ) EXISTING STRUCTURE TOTAL AREA OF PROPERTY SQ. FT. IMPERVIOUS SURFACE SQ. FT. BOX 9 PLUMBING FIXTURES (Including 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. BOX 10 Water Service meter size (if known) Also see BOX 4 BOX 11 Septic Tank — Not generally allowed in the City of Spokane Valley. For special circumstances contact Your sewer purveyor and the Health District (See BOX 4) BOX 12 Street use may require a " Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public Works Department. I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE. OWNER / AGENT DATE .S" 5 " 0 3 (OVER) 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 Holder Signature OFFICE USE ONLY - PLEASE DO NOT WRITE BELOW THIS LINE ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT PLANNING DEPARTMENT APPROVAL DISAPPROVAL REMARKS DATE SEPA: EXEMPT NOT EXEMPT • .1 FIRE DEPARTMENT APPROVAL 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 BUILDING SQ. FT. @ = BUILDING SQ. FT. @ = BUILDING SQ. FT. @ = • BUILDING SQ. FT. @ = TOTAL SQ. FT. TOTAL VALUATION BUILDING PERMIT NO. PLAN CHECK FEE RECD RECEIPT NUMBER PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE OTHER CHARGES I AMOUNT DUE BUILDING DEPARTMENT APPROVAL BY DATE ASSIGNED ADDRESS q2) x40 Pbc6- Qyl'41_ G.) •6(5. (Di 5 teT QA CAL- "rLbtfi\. "ts GArLAL)15' APPROVED BY --)14 CZte 7/1 ef s e Sdat-tteA vhcJ ofotl" 9o* ga 36 oat. 5 CA 6054- V\ 4N6 3 Ns 0,3T Or's& iq 06 -‘41 55 Cc5“.. 31 eyi: ,44 C C (.C: Jo'