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2003, 04-01 Permit App: BD-03-008 Antenna, EquipmentCity of SPOKANE VALLEY PERMIT # BUILDING PERMIT APPLICATION 0 David E. and Deborah U. Davenport Box 1 OWNER JOB LOCATION 2205 S. Conklin Road OWNER'S ADDRESS Same CITY Spokane Valley PHONE 922-2536 DESCRIBE JOB Replace antenna and install associated electronic equipment THIS PROPERTY IS OWNED BY: SINGLE/MARRIED X PARTNERSHIP CORP. 1/ BOX 2 CONTRACTORS NAME Pass Word, Inc. CONTRACTOR'S ADDRESS 1303 W. First Ave. PHONE 624-5235 CITY Spokane CONTRACTOR'S REG.# PASSWI*985L5 EXPIRATION DATE 6/25/2004 (CARD MUST BE PRESENTED AND COPIED) V BOX 3 CONTACT PERSON OF PROJECT Rodney J. Bacon PHONE 624-5235 ADDRESS 1303 W. First Atte CITY Spokane ZIP 99201-4190 BOX 4 SEWER AVAILABILITY WATER AVAILABILITY BOX 5 ESTIMATED PROJECT COST $ ono EXISTING BLDG. VALUATION $ BOX 6 PROPERTY TAX ACCOUNT NUMBER 45251.0403 LEGAL DESCRIPTION Lot 3 Block 4 in Ridgemont Estates No. a, situated in the southerly portion of the NE 1/4 of Township 25 Range 44 Section 25, Spokane County, Washington with address (IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) CENSUS NUMBER LOT NUMBER 2205 S. Conklin Rd. BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR / 2ND FLOOR / 3RD FLOOR / BASEMENT GARAGE / CARPORT JBOX 8 (x) SINGLE FAMILY ( ) MULTIFAMILY (NO. OF UNITS ( ) COMMERCIAL / INDUSTRIAL ( ) TENANT IMPROVEMENT / DECK / / TOTAL / ( ) NEW CONSTRUCTION (X) EXISTING STRUCTURE TOTAL AREA OF PROPERTY SQ. FT. IMPERVIOUS SURFACE SQ. FT. BOX 9 PLUMBING FIXTURES (Including rough -ins) NO. WATER CLOSETS - URINAL BATHTUBS -FAUCETS PRIVATE SEWER SYSTEM SHOWERS LAVATORIES SINKS DISHWASHERS ELECTRIC HOT WATER HEATER LAUNDRY WASHER OUTLET LAWN SPRINKLER SYSTEM DRINKING FOUNTAINS SUMPS, SPRINKLER VACUUM BREAKERS FLOOR DRAINS BACKFLOW PREVENTER VACUUM TYPE BREAKER HOT TUBS TOTAL FIXTURES MECHANICAL APPLIANCES GAS PIPING : OUTLETS NO. FURNACE, ELECTRIC GAS (BTU RATING GAS HOT WATER HEATER CONVERSION BURNER BOILER: SIZE AIR HANDLING UNITS HEAT PUMPS: SIZE UNIT HEATERS AIR COOLING UNITS; SIZE COMMERCIAL HOOD GAS APPLIANCES FIREPLACE INSERTS EXHAUST VENT FANS APPLIANCE VENT REPAIR WOOD STOVE SYSTEM TOTAL UNITS OVER BOX 10 WATER SERVICEMETER SIZE (IF KNOWN) (ALSO SEE BOX 4) BOX11 SEPTIC TANK - NOT GENERALLY ALLOWED IN THE CITY OF SPOKANE VALLEY. FOR SPECIAL CIRCUMSTANCES CONTACT THE SEWER PROVEYOR AND THE HEALTH DISTRICT. (SEE BOX 4) BOX 12 STREET USE MAY REQUIRE A "STREET USE PERMIT" FOR SEWER, WATER , SIDEWALKS, 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 TOP FORM THE WORD. OR WHICH THE APPLICATION IS MADE. / OWNER / AGENT 4 ,d tic-( DATE 3/27/2003 OFFICE USE ONLY - PLEASE DO NOT WRITE BELOW THIS LINE ZONE SETBACKS: FRONT PLANNING DEPARTMENT APPROVAL SIDE REAR HEIGHT LIMIT DISAPPROVAL DATE REMARKS SEPA: EXEMPT NOT EXEMPT FIRE DEPARTMENT APPROVAL DISAPPROVAL DATE 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. @ = SQ. FT. @ = SQ. FT. @ = SQ. FT. @ = TOTAL SQ. FT. TOTAL VALUATION BUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE OTHER CHARGES AMOUNT DUE BUILDING DEPARTMENT APPROVAL BY ASSIGNED ADDRESS RECEIVED ACCEPTED FOR FILING PLAN FRFC OR© LST Pf}NE L. A.vTE' -' 1 ,..cs- I G -R04.1 CITY OF SPOKANE VALLEY APPROVED FOR SUBMITTAL Initials ; Date Building Planning Public Works fri- l A)gAgOL1c /SN AA'7EAeAeq (Aa►3,.►. II E A Ac et ro wRE )f Air 4dM-444rkioR,t_eD 4 cC6Ss. ,-, T 2' `vJ lc x <3 N Nom 7" wes r eotea,ESfwb. otic ro PoroarpH 2. REGISTERED AS PROVIDED BY LAW AS CONST CONT GENERAL REGIST. # EXP. DATE CCO] "PASSWI*985L5 06/25/2004 EFFECTIVE DATE 06/25/2002 PASS WORD 'INC ''{ 1303 W FIRST AVE STE 200 SPOKANE(, -WA► 99201 Signature 1 -"Nd -C. Issued by DEPARTMENT OF AB AND INDUSTRIES