2004, 04-09 Permit App: BLD-04-04037 DuplexSpokane
jValley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
NEW SINGLEFAMILY RESIDENTIAL
Job Address: 4035 S BOWDISH RD
SPOKANE VALLEY WA 99206
Description: NEW DUPLEX W/CARPORTS - NATURAL GAS
Subdivision:
Owner:
Applicant:
Address.
Contractor:
Address.
COURCHAINE, SAM
COURCHAINE, SAM
4029 S BOWDISH RD
SPOKANE, WA 99212
Application #: BLD -04-04037
Lot: BIk: Parcel No:
Phone: (509) 928-2807
Phone:
Lic No:
Applied:
Issued:
Expires:
Zoning:
04/09/2004
10/06/2004
General Information:
TYPE OF RESIDENTIAL PERMIT
VALUATION
BUILDING HEIGHT TO PEAK
DIMENSIONS
# OF STORIES
# OF BEDROOMS
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
CURRENT PROPERTY SIZE
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
TOILETS
TUBS
SINKS
DISHWASHER
CLOTHES WASHER
WATER USING DEVICE
FUEL BURNING APPL <= 100,000
DRYER
FUEL BURNING WATER HEATER
GAS PIPING (ea. OUTLET)
VENTILATING FANS
TYPE II HOOD
dup
233571
13'4"
44' X 68'
1
6
45
25
30
35
r-3
5-n
1
132 X 140
no
no
4
4
6
2
2
2
2
2
2
4
8
2
Fees:
PLAN CHECK FEE
BASIC PERMIT FEE
WSBCC SURCHARGE
TOILETS
TUBS
SINKS
DISHWASHER
CLOTHES WASHER
WATER USING DEVICE
FUEL BURNING APPL <= 100,000
DRYER
FUEL BURNING WATER HEATER
GAS PIPING
VENTILATING FANS
Total Calculated:
Deposits/Receipts:
Total Due:
CITY OF„ SPOKANE VALLEY
APPROVED FOR SUBMITTAL
697.66
1,744.15
4.50
24.00
24.00
36.00
12.00
12.00
12.00
30.00
20.00
20.00
4.00
80.00
2,720.31
0.00
2,720.31
9.77D:3I
Ulitials / Date_ j
REVIEWED FOR CODE COMPLIANCE
Building �=' ] SPO j VALLEY BUILDING DIVISION
P
Public Works
a
THIS IS NOT A RECEIPT
h
Spokane
4.0 Valley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone:. (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address:
uaaci C'4ObS1\
Assessor's Tax Parcel Number(s): y5 33&I • 5.357
Legal Description: Tkt Sa}L I40' oG_F1�._ t z�k `{40 0J +L Ecst�' oE}k.* Wed
of t NW '< of kms.sS ok Scc.!33 tons p ay, R,,ngt_yy
PERMIT DESCRIPTION:
Q Building Permit
❑ Relocation
Neu e_x
❑ Change in Use ❑ Grading ❑ Manufactured Home
n Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: So ' C>;wrc_1-Nc.,,tt_
Phoners, ,;)&o7 Faxe,oGD9aL awl;
Address: 40W1 S Row dist,
Kam \ 1\9 wA G9a66
State Zips -Code
City
Contractor: Sr, Cav,chesnv__
Phone: epq) 9aB•a88-1 Fax: .tot) 9` 3d-11
Address: yeya°, s Rto., a�S\
o,1e Wk.i WP 99a06
City State Zip Code
WA State Contractor License #:
330'
❑ Applicant: Sar, (ov,+-r1w.2(o_
Phone:Gco;)gatk-a367 Fax: (50s)4a6 8o4►I
Address: 4aa9 S. Rowd;sp
�oke.,,. VJlt WA qv,8A6
Ci[y I State Zip Code
Architect:
Phone:
Address:
0tontr
Fax:
City
Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
13t^+ 4:n•
DIMENSIONS:
ttIXbH
# OF STORIES:
1
MAIN FLOOR TO SQ. FTG:
141V l 6 cJ Si Lt
2 FLOOR SQ. FTG:UNFIN
—
(
!
BASEMENT SQ. FTG:
—
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
19 °
L
DECKJCOV. PATIO SQ. FTG
sa, 2l ti Q CO-t-ffr
Id
OCCUPANCY GROUP:
QA•1: e .,,4; o, l
CONSTRUCTION TYPE:
tOcia el Fri_
HEAT SOURCE:
Eros
# OF BEDROOMS:
3 etch sad_
TOTAL HABITABLE SPACE:
o49a {i`
IMPERVIOUS SURFACE AREA:
3410° ss ft
COST OF PROJECT:
30% SLOPES ON PROPERTY:
No
SEWER OR ON-SITE SEPTIC
SYSTEM? &tu4 r
t4)
MANUFACTURED HOME
Width:
Manufacturer:
Length: Year: Pit Set:
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City State
Inspector: = Phone: Fax:
Address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
j
❑ BOLTING`'
Firm Name:
\CONCRETE
REINFORCEMENT in WELDING
Phone:
Inspector(s):
Fax:
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
*lane
Valley
Project Address: 3- 90 a'j S Row 4,1 $1,.
Owner: �o Colic_ wit.i_
Mailing Address: Li 0 c, &J sL
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Contractor: O wY1.Lr License #:
Mailing Address:
Phone (Daytime Contact): Sot) q2 -z801
SookII LSA q�gol
City State Zip Code
Phone #:
AUTHORIZED SIGNATURE
Zip Code
City State
DESCRIPTION OF WORK
# OF
UNITS
X
COST
TOTAL
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
p`„_
X
515.00
=
AMOUNT
2
FUEL BURNING APPLIANCE
More than 100,000
X
519.00
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
$50.00
=
4
UNLISTED APPLIANCE (Additional Fee)
USED
More than 400,000
X
5100.00
5
APPLIANCE(WSEC min. AFUE
rating)
USED APPLIANCE
Equal to or less than 400,000
X
$50.00
=
6
(WSEC min. AFUE
rating)
More than 400,000
X
=
7 BOILER/REFRIGERATION 1 - 100M BTU
X
5100.00
$15.00
=
8 BOILER/REFRIGERATION 101 - 500M BTU
X
$28.00
=
9 BOILER/REFRIGERATION 501 - 1,000M BTU
X
10 BOILER/REFRIGERATION 1,001 - 1,750M BTU
X
$39.00
$57.00
=
11 BOILER/REFRIGERATION More than 1,750M BTU
X
$95.00
=
12 GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
=
13 RANGE
X
510.00
=
14 DRYER
X
15 FUEL BURNING WATER HEATER
X
$10.00
510.00
=
16 MISC. FUEL BURNING APPLIANCE
X
510.00
=
17 GAS PIPING (each outlet)
X
=
18 DUCT SYSTEMS
X
51.00
$10.00
19 VENTILATING FANS -
v 6
x
510.00
_
20 AIR HANDLER (DOES NOT include ducting) Equal to or less than 10,000 CFM
X
512.00
21 AIR HANDLER (DOES NOT include ducting) Greater than 10,000 CFM
X
$79.00
=
22 EVAPORATIVE COOLERS
X
$10.00
23 TYPE I HOOD
X
=
24 TYPE II HOOD
X
$50.00
$10.00
25 HEAT PUMP/AIR CONDITIONER 0-3 TON
X
512.00
=
26 AIR CONDITIONER 3-15 TON
X
$20.00
=
27 AIR CONDITIONER 15-30 TON
X
$25.00
=
28 AIR CONDITIONER 30-50 TON
X
$35.00
=
29 AIR CONDITIONER More than 50 TON
X
$60.00
=
30 LPG STORAGE TANK
X
$10.00
=
31 WOOD OR PELLET STOVE/INSERT
X
$10.00'
=
32 WOOD STOVE - FREE STANDING
X
525.00
_
METHOD
0
CARD#:
OF PAYMENT:
CASH 0 CHECK 0 VISA 0 MC DATE:
EXPIRES:
SUBTOTAL
=
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE
Zip Code
SGpokane
4 Valley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use: (2psjcitnl�la�
Project Address: LIO13g)LJaosh
Owner: car, Cc.>n.-c c,S..e_
Mailing Address: 1-10 aq
Contractor: 0 w Ac -r -
Mailing Address:
Phone (Daytime Contact): ( SOS )613%t a' i
. Sc CStateity kP pc
t td W ZPO ode
License #: Phone #
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
q
X
$6.00
=
2
URINALS
n
X
56.00
=
3
TUBS
-1
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
0
X
56.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6.00
=
6
DISHWASHER
X
56.00
7
CLOTHES WASHER
rQ
*\
X
$6.00
=
8
GARBAGE DISPOSAL
0
X
$6.00
=
9
WATER SOFTENER
0
X
$6.00
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
0
X
$6.00
=
11
FLOOR DRAINS
AREA. CASE, COIL, TRENCH,
CONDENSATE
i,
X
56.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
X
$6.00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
56.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
•535.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
City of
2001 WSEC.Residential Compliance Form
Prescriptive (Ciapter 6) Options for all R Occupancies, Climate Zone 2 0
Heat source: ALL
SPOKANE VALLEY BUILDING DEPARTMENT
11707 E. Sprauge Avenue, #106, Spokane Valley, Washington 99206 - Tel 509-921-1000 - Fax 509-921-1008
1
SITE ADDRESS: goa9 S Sow 1-1s%x PERMIT NO. DATE: L) OL
INSTRUCTIONS
1) Your permit will be processed more efficiently if
help you with general questions about this form.
exceptions or substitutions.
2) Glazing percentage determines which option to
proceeding to the option table below.
GLAZING AREA CALCULATION:
QS%
you provide all of the requested information. Department staff can
Your building must match the selected option requirements without
choose. Complete the following glazing area calculation before
SF. — :99 SE =
TOTAL WINDOW AREA - HEATED FLOOR AREA (ALL FLOORS) _
10 %'
OF GLAZING
NOTE: Use rough opening (R/O) for Window area. Include all half -lite and full -lite door glazing in this
calculation.
CAN'T COMPLY? If none of the Prescriptive (Chapter 6) Options below are acceptable, consider systems analysis
(Chapter 4) or; Component Performance (Chapter 5) Approach. The main advantage is flexibility to juggle individual U -
factors (R -values) as long as an overall maximum value isn't exceeded. Note that the overall performance requirements
are no less stringent than the Prescriptive requirements. Calculations may be performed- by hand or, using an acceptable
computer software program. Helpful forms and other resources can be downloaded at http://wwcv.eriergy.wsu.edu/
•
buildings.
INSPECTORS COPY
5K4fl�h1S
0. Nominal R -values are for wood frame assentlies only or assemblies built in accordance with Section 601
1. Mninum requirements for each option listed. For example, if a proposed design has a glazing ratio to the conditioned floor area o 13%, it
shall cnrrpiy with an of the requirements of the 15% glazing option (or higher). Proposed designs, which cannot meet the specific
requirements of a fisted option above, may calculate mmpflance by Chapters 4 or 5 of this Code.
2 Requirement applies to all ceilings except single rafter or joist -vaulted ceilings. 'Adv' denotes Advanced Framed Ceiling.
3. Requirerrent applicable only to single rafter or joist vauted ceilings.
4. Below grade walls stall be insulated either on the exterior to a minimum level of R-12, or on (he interior to the same level as walls above
grade. Exterior insulation installed on below grade walls shall be a water resistant rreterial, manufactured for its intended use, and installed
according to the manufacturers specifications. See Section 602.2
5. Floors over crawl spaces or exposed to ambient air conditions.
6: Required slab perimeter insulations shall be a water resistant material, -manufactured for its intended use, and installed according to
rrenufadurer's specifications. '
7. Int denotes standard framing 16 inches on center with headers insulated with a minimum or R-5 insulation.
8. This wall insulation requirement denotes R-19 wall cavity insulation plus R-5 foam sheathing.
9. Doors, including all fire doors, shall be assigned default U -factors fromTable 10-6C.
10. Where a maximum glazing area is listed, the total glazing area (combined vertical plus overhead) as a percent of gross conditioned floor area
shall be less than or equal to that value. Overhead glazing with (-factor of U--4.40 or less is not inducted in glazing area limitations.
11. Overhead glazing shall have tl-factors determined in accordance with NFRC 100 or as specified in Section 502.1.5.
12. Log and solid tinter walls with a minimum average thickness or 3.5 are exempt form this insulation requirerenL
Form 5-050801-2001 Residential Comp Form
Option
Glazing
Area": % of
Floor
Glazing U -Facto
Door'
U -factor
Ceiling
'
Valuted
Ceiling'
Wall
Above
Wall'tnt'
Below
Grade
Wall'
Below
Grade
Floor'
Slab'
GradeGrade
Vertical
Overhead"
•
L
10%
0:40
0.58
0.20
R-38
R-30
R-21 int
R-21
.
R-12
R-30
R-10
•
II.'
15%
0.40
0.58
0.20
R-38
R-30
R-19 +
R5°
R-21
. R-12
R-30
R-10
❑
• III.
17%
0.37
0.58
0.20
R-38
R-30
R-19+.
R-21
R42
R -30R-5°
•
R-10
❑
IV.
Unlimited
Group R-3
C*Ocnipa�'
Only
. 0.35
0.58
0.20
R-38
R-30
R-21
int'R-21
R-12
R-30
R-10
0. Nominal R -values are for wood frame assentlies only or assemblies built in accordance with Section 601
1. Mninum requirements for each option listed. For example, if a proposed design has a glazing ratio to the conditioned floor area o 13%, it
shall cnrrpiy with an of the requirements of the 15% glazing option (or higher). Proposed designs, which cannot meet the specific
requirements of a fisted option above, may calculate mmpflance by Chapters 4 or 5 of this Code.
2 Requirement applies to all ceilings except single rafter or joist -vaulted ceilings. 'Adv' denotes Advanced Framed Ceiling.
3. Requirerrent applicable only to single rafter or joist vauted ceilings.
4. Below grade walls stall be insulated either on the exterior to a minimum level of R-12, or on (he interior to the same level as walls above
grade. Exterior insulation installed on below grade walls shall be a water resistant rreterial, manufactured for its intended use, and installed
according to the manufacturers specifications. See Section 602.2
5. Floors over crawl spaces or exposed to ambient air conditions.
6: Required slab perimeter insulations shall be a water resistant material, -manufactured for its intended use, and installed according to
rrenufadurer's specifications. '
7. Int denotes standard framing 16 inches on center with headers insulated with a minimum or R-5 insulation.
8. This wall insulation requirement denotes R-19 wall cavity insulation plus R-5 foam sheathing.
9. Doors, including all fire doors, shall be assigned default U -factors fromTable 10-6C.
10. Where a maximum glazing area is listed, the total glazing area (combined vertical plus overhead) as a percent of gross conditioned floor area
shall be less than or equal to that value. Overhead glazing with (-factor of U--4.40 or less is not inducted in glazing area limitations.
11. Overhead glazing shall have tl-factors determined in accordance with NFRC 100 or as specified in Section 502.1.5.
12. Log and solid tinter walls with a minimum average thickness or 3.5 are exempt form this insulation requirerenL
Form 5-050801-2001 Residential Comp Form
,. -2001
WASHINGTON STATE ENERGY CODE UPDATE
This brochure is provided to assist in deciphering some of the Energy Code updates, and focuses primarily on
RESIDENTIAL changes of significance. This notice does not contain all of the changes occurring in the 2001 WSEC.
• Chapter 6, Prescriptive Requirements Approach — The code is now fuel -blind. Two tables (6-1, 6-2) replace six
previous tables. Table 6-2 is applicable in Climate Zone 11, Eastern Washington.
• Table 6-2 offers four options to achieve compliance based on the percentage of glazing in the home. Two
options (1, IV) require wall insulation values of R-21, the remaining two options gill) require R-19 + R-5
foam sheathing. There are no substitutions permitted for the foam -sheathing requirement in. Options II, M.
*Hint: 1f your home design falls within the parameters of Options II or III, you may select option IV thus
permitting unlimited glazing area with U -factors of 0.35 or better. The benefit: you may then use the R-21
batts for wall insulation.
• Glazing 1J -factors of 0.40 are the minimum efficiency requirements for windows, and some instances may
require U -factors of 0.35.
• Minimum door U -factors are 0.20.
• Options I and IV require headers to be insulated to R-5 minimum.
• Ceiling insulation R -values have not changed.
• Compliance through Chapters 4 and 5 (heat loss calculations) may still be used, however, the Wattsun
program is being phased out. A. new spreadsheet will be available soon through the WSU Energy Extension
Program and will be available on-line at: www.energy.wsu.edu/buildings/. In the mean time, if you use the
Wattsun software it must be version 5.7 for acceptance. Note: It will be increasingly difficult to show
compliance with un -insulated basement walls.
REMINDER — VIAQ/WSEC REQUIREMENTS
Compliance has been off the mark in the following areas of the Ventilation & Indoor Air Quality Code/Energy
Codes since they became effective July 1, 2001.
• Labels must be provided on the whole house ventilation controls (e.g.; 24 hour timer), which read: "Whole
House Ventilation (see operating instructions)." Instructions must also be provided for the homeowner
describing the Whole House Ventilation System's operation.
• HVAC ductwork/furnace cabinets outside the conditioned space (attic, crawl space, garage) or stud bays, joist
cavities/spaces used to transport air must be sealed with welds, gaskets, mastics or mastic -plus -embedded -fabric
systems. UL 181A tape is permitted for rigid glass ducts, and UL 181B tape is permitted for flexible ducts.
Common duct tape is not permitted unless: the HVAC equipment (air handler in the case of heat pumps) and
ductwork are located entirely within the conditioned space.
ONLY ONE FORM!
Attached is the new Washington State Energy Code Compliance Form containing Table 6-2, which reflects the
upcoming insulation values. This form must be used if you choose to comply by the prescriptive approach (no
calculations necessary). This must be completed prior to receiving your permit.
For questions and information regarding these changes please contact our office at: 477-3675, or visit Washington State
University Energy Extension Program web site: www.energy.wsu.edu/buildings/
sal
*lane
Call 24Ahours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit # 04-227 Account #
ROW CONSTRUCTION PERMIT
Location of property 4035 S. Bowdish Rd.
(Address/Parcel #, if available)
Applicant Name Sam Courchaine Fax
Address 4029 S. Bowdish Rd. Spokane Valley, Wa. 99212 Phone 509-928-2807
Contractor's Name
Address
Phone
Contractor's Reg.# Expires
IPR�OJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
U Sewer Connection ■ Driveway
D Curb & Gutter Gas Installation/Repair
• Cable/Conduit/Pole
fl Water Installation/Repair
D Pavement Cut
❑ Sidewalk Repair/Construction
fl Other
Dimensions
Bond/insurance certification must be on file with the City. Bond #
SPECIAL CONDITIONS: Construct driveway approach per Spokane County Standards as
adopted by the City of Spokane Valley.
See attached Provisions
Permittee Signature
Approved Date c/ /Y1
el
I hereby authorize the City of Spokane Valley to charge the fee for this permit to.my credit card.
Card # _ Expiration Date
Name of Holder
Signature
Fees Paid$ 25.00
25.00
Date
Init
(Application) (Inspection)
In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on
each permit will be billed to the permittee at a rate of $50.00 per hour with a $25.00 (1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily (Signed)
Permit not valid until One -Call Notification Ticket # entered here
Date
PERMIT MUST BE KEPT ON SITE
ADDRE
ZONE
ROAD
FR
COM
REVI
f re / )
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40 SP 25/4s3
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rui/mace G>'PN�/! Qn /%11°ivr.�/Jd� ✓i -e
7; Zf $cl:.'J/4J/l-o( �J
RECEIVED
DM2g6A3
SPOKANE VALLEY
DEPART OF
SOM MUSK Y 0`-vElOMEN
7_
Union CI.O
N
Painted H
Golf Cou
This site pilin is being sebinhied Nt fbe pmp.e of
nown fooperly
oblfining a eliding panne and is a Depend Dermot
,fifes/d!menbmos,cutb lllnnessiniebeeoposal. AN eand ammo
nave beenl ldeMilied. Also wm
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Signed: ��`7— .. ,
bele:
>t.
hl:.
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E 1:::
) 1, } CSN
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THIS BUILDING SUBJECT
TO FIELD INSPECTION CORRECTIONS
E, slurs. b
11
35
) I.- RA
020.19
REVIEWED FOR CODE
SPDKANE VALLEYBUILDING DIVISION
CITY COPY