HomeMy WebLinkAbout2003, 04-01 Permit App: BD03-013 Storage BldgCity of
SPOKANE VALLEY
PERMIT # &.013
BUILDING PERMIT APPLICATION
Box 1 OWNER (�2Y1.2 YYLLL{,OA. ' . JOB LOCATION 4) 10 S. Hol)ou3 eL
OWNER'S ADDRESS -0E4_ 14 1 CITY±�pth n nom_ PHONE G CWP 175"
DESCRIBE JOB J)L Li_.1 CL Otd 11 CC" Lei C.2-1
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED DC PARTNERSHIP
CORP.
BOX 2 CONTRACTOR'S NAME
PHONE
CONTRACTOR'S ADDRESS CITY
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED)
BOX 3 CONTACT PERSON OF PROJECT J(r / u on Fat/ 1. PHONE qc&(9 ^ (i
ADDRESSID64. phi o(67 CITY1444 ZIP C -/ai�
BOX 4 SEWER AVAILABILITY ✓ WATER AVAILABILITY ✓
BOX 5 ESTIMATED PROJECT COST $ 1rj DOZ
EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER 115333 • I CD4
LEGAL DESCRIPTION i J1, ki i D K 1 eot eS6
k newt clow s I sl-- Add L
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR 3- 5D/ 2ND
FLOOR /
3RD FLOOR / BASEMENT
GARAGE / CARPORT
/ DECK /
/ TOTAL /
BOX 8 ( KSINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
( /) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY
IMPERVIOUS SURFACE 320 D
SQ. FT.
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
L_) 51/ ,
OVER
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 d+OS
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
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. @
BUILDING SQ. FT. @ =
BUILDING SQ. FT. @
BUILDING 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