2009, 03-18 Permit App: 09000595 DuplexProject Number: 09000595 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 3/18/2009 Page 1 of 3
Project Information:
Permit Use: DUPLEX -SEWER Contact: WATSON CONSTRUCTION
Address: 1321 E. 18TH AVE
C - S - Z: SPOKANE, WA 99203
Setbacks: Front Left: Right: Rear: Phone: (509) 990-5546
Group Name:
Site Information: Project Name: 11706/11708 E JACKSON
Plat Key: Name: Range
District: Nort
Parcel Number: 45091.3025 Block:
SiteAddress: 11706 E JACKSON LN
Location:: CSV
Zoning: MF -1 MF MDR District
Water District: 026 IRVIN
Area: 6,141 Sq Ft Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Lot:
Owner: Name: SVG VIEW RANCH, LLC
Address: 2910 E 13TH AVE
SPOKANE, WA 99202 -
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Review Information:
Review
Building Plan Review
Released By:
Originally Released: 3/16/2009 By: tmclbourn
Landuse/Zoning/HE Conditions
Released By:
Sewer Review
Permits:
Originally Released: 3/18/2009 By: CJJANSSE
Released By:
Operator: jmm Printed By: jmm
Print Date: 3/18/2009
Project Number: 09000595
Inv: /
Application
Date: 3/18/2009 Page 2 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: WATSON CONSTRUCTION
Address: 1321 E. 18TH AVE
SPOKANE, WA 99203
Item Description
APPROACH -CONST IN ROW
Contractor: WATSON CONSTRUCTION
Address: 1321 E. 18TH AVE
SPOKANE, WA 99203
Description Grp Tvpe
1&2 FAMILY R-3 VB
2ND FLOOR R-3 VB
DECK OPEN R-3 VB
GARAGE U-1 VB
Item Description
RESIDENTIAL PERMIT FEE
WSBCC SURCHARGE
SF PLNS RVW < 7999 SQ FT
Notes
Contractor: WATSON CONSTRUCTION
Address: 1321 E. 18TH AVE
SPOKANE, WA 99203
Item Description
DUCT WORK SYSTEM
GAS WATER HEATER
GAS APPLIANCE<=100,000BTU
GAS PIPING
VENTILATING FANS I DUCT
CLOTHES DRYER
RANGE
GAS LOG OR GAS INSERT
HOOD -TYPE 11
Approach
Firm: WATSON CONSTRUCTION
Phone: (509) 990-5546
Units Unit Desc
1 NUMBER OF
Permit Total Fees:
Building Permit
Fee Amount
$50.00
$50.00
Firm: WATSON CONSTRUCTION
Phone: (509) 990-5546
This Application: Total Project:
Sq Ft Valuation Sq Ft Valuation
1,400 $135,562.00 1,400 $135,562.00
1,545 $115,380.60 1,545 $115,380.60
55 5825.00 55 $825.00
860 516,340.00 860 $16,340.00
Totals: 3,860 5268,107.60 3,860 $268,107.60
Units
1
1
1
Unit Desc
SELECT
SELECT
SELECT
Fee Amount
$1,940.15
$4.50
$776.06
Permit Total Fees: $2,720.71
Mechanical Permit
Firm: WATSON CONSTRUCTION
Phone: (509) 990-5546
Units Unit Desc
2 NUMBER OF
2 NUMBER OF
2 NUMBER OF
2 # OF UNITS
8 NUMBER OF
2 NUMBER OF
2 NUMBER OF
2 NUMBER OF
2 NUMBER OF
Operator: jmm Printed By: jmm
Permit Total Fees:
Print Date:
Fee Amount
$22.00
$22.00
$26.00
52.00
$88.00
520.00
$20.00
$22.00
$22.00
$244.00
3/18/2009
Project Number: 09000595 Inv: /
Application
Date: 3/18/2009
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: WATSON CONSTRUCTION
Address: 1321 E. 18TH AVE Phone: (509) 990-5546
SPOKANE, WA 99203
Plumbing Permit
Page 3 of 3
Firm: WATSON CONSTRUCTION
Item Description
TOILETS/BIDETS
SINKS
TUBS
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
MISCELLANEOUS FIXTURES
Units Unit Desc
6 NUMBER OF
8 NUMBER OF
4 NUMBER OF
2 NUMBER OF
2 NUMBER OF
2 NUMBER OF
4 NUMBER OF
Permit Total Fees:
Notes ,
Payment Summary: c
Permit Type
Approach
Building Permit
Mechanical Permit
Plumbing Permit
Fee Amount
$36.00
$48.00
$24.00
$12.00
$12.00
$12.00
$24.00
$168.00
Fee Amount
$50.00
$2,720.71
$244.00
$168.00
Invoice Amount
$50.00
$2,720.71
$244.00
$168.00
Amount Paid
$0.00
$778.30
$0.00
$0.00
Amount Owing
$50.00
$1,942.41
$244.00
$168.00
$3,182.71 $3,182.71 $778.30 $2,404.41
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: jmm Printed By: jmm Print Date: 3/18/2009
Spokane
aesvalley
Community Development
Pennit Center
11703 E Sprague Ave, SuiteiB+43Y
Spokane Valleyv'M920"6!x,-40.10:
(509)688-0036'FAX�;(SB9)S' k-003317
www.spok�i gri�ti , ur•• 3 20
Residential Construction
Permit Application
SITE ADDRESS
ASSESSORS PARCEL NO: ISO CiI , SO ZS LEGAL DESCRIPTION: (SOT ZS 16o01/C 3
M(m cttIt
PERMIT NUMBER:
PERMIT FEE:
onstruction
Addition/Remodel
n Other:
Accessory Bldg
Deck
11 7 u& / %r1t ISIAt4c 1/4 111 , /-Ja 1 cYZoC
Building Owner:
Contractor:
Name: / \
f Y15 (_/Olt SDS
Name: w4. -r ht1 car say Cflevl
Address: 1311 G fg& A��
G
Address:, i :- / R-- �
Stater Ztp.�r�Zo3
City: ol,-�,
City:
��li p ice State: �1i 7ilne-113
/
Phone: *Pi-TS41-/0S3 Fax:�1- y' D33
�Jc
Phone:/,'/ttet-�i2.15 Fax:57'55/n°.33f
ICOV. P • ' O SQ. FTG:
53 - 9 --t
Contractor Lic o Exp Date:
4VattSOG 1ogNg 7 -/o -.ZD /o_
Contact Person
CONSTRUCTION TYPE:
trt/G /ALA /4-
City Business Lic. No: /4..
-Name:
O$ I 1 1 go
(4w s i�oitTSn-'/'
Phone: Hopi -'ZI Z
Describe the scope of work in detail:
Cost of Project: $ 250(TOO eft
Srfrc•- (ou, Tk Soloiet nn 1(nnt- Log -
Proposed Use: Oto1'1e,r 0CEi0i(i e/&- r'syeft 1
**************The following MUST be complete: (write N/A if not applicable)**********************
HEIGHT TO PEAJ:
DIMENSIONS:
A 50
# OF STORIES:
AS
TOTAL HABITABLE SPACE:
MAIN FLOOR TO SQ..
FTG: / yf'Z� /700
2"u FFLCOOR SQ. FTG:'/ _
'. /Ce
UNFIN BMENT SQ. FTG:
/) �i
IMPERVIOUS SURFACE
AREA: ztc7 O
FINISHED BASE ENT
SQ. FTG: /(Jrf%
GARAGE SQ. FTG:DE
!off
ICOV. P • ' O SQ. FTG:
53 - 9 --t
30% SLOPES ON
PROPERTY: ,Oo
# OF BEDROOMS:6^
W
CONSTRUCTION TYPE:
trt/G /ALA /4-
H �• OURCE:
r -771--S
SEWER OR SEPTIC?
See:/n/Q-('
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. 6) Plans or additional information may be required to be submitted, and subsequently approved before
this application can be pjobessed.
SIGNATURE:
Method of Paymen
0 Cash
Bankcard #:
Authorized Signature:
REVISED 2/15/07
\
LI\ Check
/
DATE:
itiog
❑ Mastercard 0 VISA
Expires: VIN#:
•
Spokane-
Valley'
Community Development
Residential Construction - r G,t,Al;i
rtnit Application
1r/OCD I 1(7QP
Permit Center.
11703 E Sprague Ave, S i e.l3, 32;
Spokane Valley„WA,`99206” ' ik1.0 1
(509)688-00361FAa_ ,(5D9)65k-0037
\wwspokfui-7a11Vu .�3 VI%
Na
3113/69
SITE ADDRESS:
NUMBER:
61 657—
;PERMIT
PERMIT FEE:
onstruction
A ttion/Remodel
Other:
Accessory Bldg
Deck
ASSESSORS PARCEL NO: 4150 R 1 • JO ZS LEGAL DESCRIPTION: GOrzS {rya( S
Building, Owner:
Name: (7j,1 yl
Wea s f\
Address:I7Jl'
State:( -26, Zip:cm zoS
City:
Phone:S7'/— S-3 LJ - /03-1. Pax: `1-s �! -/033
Contact Person
-Name:(4waS' frJot. lTi.
Phone:
Describe
ope of woi < in
ail:
Contractor:
Name: W 1�StN1 Ccit t)criM
Address:,R, /- i 75 �-,r/- at/,cam
City: �SState:/ i 1 Zitwe_03
,-`/11-`7Z1 f ax.�� S3°talo -n
Exp Date:
/ /0 20 /0_
Contractor Lac No '
Wce-t4,0C- - (el 'VG .
City Bu V ess Lic. No:
os oject $ 2Q,o ,
S
v,1 / J2ttie/' nr
Proposed Use:
Cato
Vot c4
**************The following MUST be complete: (write N/A dna applicable)***
HEIGHT TO PEA":
IFS.
DIMENSIONS:
# OF. STORIES:
TOT���ITABLE SPACE:
IMPERVIOUS SURFACE
AREA: Z-gG/ S
30% SLOPES ON
PROPERTY: /CO ' •
.
MAIN FLOORTOSQ.
' FTG l 5-7 O•
2" FLOOR/SQ. FTG:
/366,-
GARAGE SQ. FTG:
j i0
CONSTRUCTION TYPE:
UNFIN BASEMENT SQ. FTG:
/U(oc
DECK/COV. PATIO SQ. FTG:
110 -1..2NGs21/Ph.,(
FINISHED BASE ENT
SQ. FTG: -/j 4
# OF BEDROOMS:///j
HEAT SOURCE:
SEWER OR SEPTIC?
_ 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. 6) Plans or additional information may be required to be submitted, and subsequently approved before
this application can be pjotessed.r\ i _ . .
SIGNATURE: f j • DATE: =�//( i./U
Method of Payment` /
❑ Cash
.Bankcard #:
Authorized Signature:
REVISED 2/15/07
J Check
❑ . Mastercard
'Expires: '
- ❑ VISA
VIN#:
_ NIS
N.
179. i0'
10/
- iZept /FM
1 - —
V
ettegx
�cv1
PLANNING DEPT. APPROVED
evr
BYPJl RAXX j
DATE: c3IIR)0'
t -�
LOT NUMBER 25
LOT SIZE 7,399 SQ. FT
ADDRESS 11706 E.
SITE PLAN - JACKSON LANE
SCALE I" = 20'-0"
SC OF
okane
Valley®
For City Use Only
PLUS ProjectNumber
Project Address //r7O/e t. ‘t e'JY2at
11703 E Sprague Ave Suite. B-3 • Spokane Valley WA'99206'
509.688.0036 t Fax: 509.688.0037 t Pe`rmitceriter@spokanevalley.org '•
As part 'of our on-going: commitmentser
v) to customer seice during the review'process ofyour project
application, we are providing you with a TARGET DATE for the initial. technical application. review.. If for
any reason we cannot meet this date,'we"will contact you with a revised target date.. ^ ••
Your application'review TARGET DATE is
3./ /9 /n4
The TARGET DATE is the date we estimate your, project; application .wilt have had its initial. technical
review. It isnot the date for approval or permit issuance.
Tips for a Smoother Project Application Review
i Submit complete, accurate plans and documents.
Extra time may be required for re -submittals' as project application reviewers work on multiple'app/ications-and it
may be several days before thev can Look at your new or revised information,'
i Designate a specific contact person to communicate with the City.
While the person designated as the applicant's contact person with the City can be changed. -one individual with the
expertise for dealing. with reviewer comments would be the best choice for the entire review process. - . '
Call staff regarding the status of your project only after the target date shown at,the top of the page.
Although von shou/d be contacted on or by the target date, please fee/ free to contact us if you haven't heard froth us
by your target date. Staff may contact, you before the target date if the initial review is complete.' By following this
procedure, you will save time and allow the reviewers to complete the work mare.expeditiously. -
Steps in the Permit Process
L Counter Complete. Your' application has been accepted as, counter ,complete. This means all of the required,
documents, as indicated on your Pre -Application Checklist have been submitted or have' +been- approved for' deferred ,
submittal. This docs not prevent technical staff from requesting additional information as a result of their technical review.
2. Quality Check. The next step' in the' process isa quality check to make sure that the:application is'reviewable and free
from substantive Flaws that would prevent technical staff from completing the technical review once it, is. started.• When
this step is complete, your application will be routed to the appropriate staff and remain in their review queue until, it
comes up for review. • - .
3. Technical Compliance. Once an application is administratively complete, it is'routed to technical staff for compliance
review. Depending on the type of project,, technical' staff may include multiple reviewers: You should be contacted by
phone, fax, email, or mail by your TARGET DATE once the initial technical compliance review is complete; .
4. Permit Issuance. When the technical compliance review'of the application is complete,, including. any; subsequent re-
•
submittals, each reviewer will approve their sectioh-of the application and'route it -to the.Permit.Centec When all sections
of the application -are received, a Permit Specialist will process the application and contact the person specified on your
application for permit pick-up. Information regarding fees and pre -construction meetings (if required): will be "provided by
the Permit Specialist at that time.
•
WHITE - APPLICANT PINK -BUILDING FILE
REV 9/07
•
//N` Permit Center
SPIliane _ 11703 E Sprague Ave, Suite 11-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development a .ww.spukancvallev.orry
Plumbing Permit Application ❑ Commercial
PERMIT NUMBER:
PERMIT FEE:
❑ Residential
SITE ADDRESS:
70, &• Sj4 U6 -nn to✓it
Building Owner -
f
- -
Name: 4 ,/ 15 �/'JGLl�U1�l
„''
�-�/ �^t
Phone: ,..?, q/_iv z)/ Fax:st,5_5 37 —.ion
Address:
i
12 l (j — 1 s5 mit."--
City: A. icf/2 State: Zip: �%l%20j
Contractor
Name:kyr/Phone:
LrL/ Fax G�-/033
Address: i3z( r. /c1‘ frac.
D/
City: so State: � Zip: 7/�Lo3
License No: 1414-1-50 61- o 9 A ) g
City BusiAess Lic: z b g /1/ «o
Contact /� 1 _
- - - - - - -
Name: /I//w/I 5 /^vrs 0..A
Phone.
v
DESCRIPTION OF WORK -
N OF UNITS X
COST
TOTAL AMOUNT
TOILETS
WATER CLOSET, BIDETS
2
URINALS
l.�
X
$6 00
X
$6.00
3
TUBS
X
$6 00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6 00
5
SINKS
LAVS/BASINS, BAR. FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
• $6 00
6
DISHWASHER
X
$6 00
7
CLOTHES WASHER
Z
X
$6 00
8
GARBAGE DISPOSAL
z
X
$6 00
9
WATER SOFTENER
X
$6 00
10
ELECTRIC WATER HEATER
NOTE: IF GAS, SEE MECHANICAL
X
$6 00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH.
CONDENSATE
X
$6 00
12
ROOF DRAINS/OVERFLOW DRAINS
X
$6 00
13
FOUNTAINS, DRINKING
X
$6 00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING. REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6 00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6 00
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB.
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
X
$6 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
$6 00
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6 00
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
❑CASH *HECK ❑ VISA 0 MC
Garth
Car
AUTHORIZED SIGNATURE:
REVISED 0126105
EXPIRES.
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
•
spslianee
jUalley
Community Development
Mechanical Permit Application
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www spokancvallev or
PERMIT NUMBER:
PERMIT FEE:
❑ Commercial ❑ Residential
SITE ADDRESS:
I I ?o(, G 5Ac1,4S0vn L,,r
9,206
Building Owner -. ,
Name:
��;5 wal sola
Phone:
col_
Fax:
so�-S3H-/o33
Address- 1321 G_ 18'�,av�
Ll
City: 5r i�i
State: c 1 Zip: s
w 99Zo
Contractor _ _
1 -
- - -
Name: 0Alsevi enST(JUI PeA
✓
T
phone: 5-0,_L/.�p/_q 4;
7
Fax: 505-5-3CH033
Address: '3Z( c...:_. / g7Z-
City: 5,, �
State Zip:116aS
License No' w !A.r/ _/�'i '01 Ai g
�i/J.4rtrA
City Balms Lic. 4045 1/ /
',/ D
Contact city, 5
..
......
Name:
Phone: V1.7 —6I4
/3
DESCRIPTION OF WORK
# OF UNITS X
COST
= TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$12 00
2
FUEL BURNING APPLIANCE
More than 100,000
X
$15.00
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
$50.00
4
UNLISTED APPLIANCE (Additional Fee) .
More than 400,000
X
$100 00
5
' USED APPLIANCE (W SEC min AFUE rating)
Equal to or less than 400,000
X
$50.00
6
USED APPLIANCE (W SEC min AFUE rating)
More than 400,000
X
• $100.00
7
BOILER/REFRIGERATION .
1 - 100M BTU'
X
$12 00
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$20 00
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$25 00
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU '
X
$35 00
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
560 00
12
GAS LOG, GAS INSERT, GAS FIREPLACE
7
X
$10 00
13
RANGE
X
$10 00
14
DRYER
X
$10 00
15
FUEL BURNING WATER HEATER
-Z—
$10 00
16
MISC. FUEL BURNING APPLIANCE
X
$10 00
17
GAS PIPING (each outlet)
X
$1.00
18
DUCT SYSTEMS
X
$10 00
19
VENTILATING FANS
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
S
X
$10 00
X
$12 00
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
$15.00
22
EVAPORATIVE COOLERS
X
$10 00
23
TYPE I HOOD
X
$50 00
24
TYPE II HOOD
Z-
X
$10.00
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
51200
26
AIR CONDITIONER
4-15 TON
X
$20 00
27
AIR CONDITIONER
15-30 TON
X
525 00
28
AIR CONDITIONER
30-50 TON
X
$35 00
29
AIR CONDITIONER
More than 50 TON
X
560 00
30
LPG STORAGE TANK
X
510 00
31
WOOD OR PELLET STOVE/INSERT
X
$10.00
32
WOOD STOVE - FREE STANDING
X
525 00
33
REPAIR & ADDITIONS
x
$15.00
34
VENTILATION SYSTEMS
x
512.00
35
VENTILATION MECHANICAL EXHAUST
X
$12.00
36
INCINERATOR - RESIDENCE
X
519.00
37
INCINERATOR - COMMERCIAL
X
$22.00
METHOD OF PAYMENT:
CCASH l 'CHECK 0 VISA 0 MC
CARD #: 1/
AUTHORIZED SIGNATURE
REVISED 8/26/05
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
I...lf t®1 ane
Valley.
Community Development
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevallev.org
Approach Permit Application
PERMIT NUMBER:
PERMIT FEE:
PROJECT ADDRESS
START DATE
11706. E. T,Adzstnn LrM&-
ANTICIPATED CO\IPLETION DATE
Building Owner:
Name: ( 1 S L. -Jai -5014
Contractor:
Address. ,;21 �, /$'/I 44j
City: Laos{. State: -4 �• Zip4olzoj
i Fax: co%J7y'/0 S3
Phone: C07- t/ -I033
Contact Person
Namec-A✓t 5 &II/4,T5
Phone: Co'I-ire& 2,l3
PROJECT DESCRIPTION (Provide site sketch)
Residential Driveway - Doplei
Existing Curb & Gutter
Culvert Installation
Other Conditions
Name: (/t )42"x\ CopckfrXrM
Address: /32, /61.- /kit.
City: S s4Zi-C.y �t �(
Phone:.sp%'57 /-/035 . Fax. 6-07-5-544-4973
State: t-t/e- Zip:e/ 1 jt.3
Contractor Lic No:kin/roc gi*C p Date: ozlo7 �11
City Business Lic. No: hop) .g....
Commercial/Industrial Driveway
Rural Road Section
Sidewalk Repair/Construction
Bond/Insurance certification must be on file with the city.
DISCLAIMER
The permittee verifies, acknowledges and agrees by their signatures 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 thts 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. 6) Plans or additional information may be required to be submitted, and subsequently approved before this
apphcation can be -essed.
Signature
Method of Payment.
❑ Cash
Bankcard #:
Authorized Signature:
REV mtrom
Check
Date Zi/0/0of
❑ Mastercard ❑ VISA
Expires: VIN#:
IRVIN WATER DISTRICT NO. 6
11907 E Trent Ave
Spokane, WA 99206
(509) 924-9320 Fax (509) 924-9084
APPLICATION FOR WATER METER SERVICE
Assigned account # 1410 / (n - O
PLEASE PRINT LEGIBLY.
Li/ 7Al CY
DATE SUBMITTED
APPLICANT 41 S /14471 CI t/C-Ti Cly) — S / ,c 1`So�
ADDRESS J 324 C . I Th Al/ -P
CITY/STATE/ZIP CnV,,,./.0 v. )/-
TELEPHONE NO. — cen-534-10 'T FAX NO.
-s3t►- /033
PROPERTY OWNER kn)ci i (oi 1-470 c'i v✓1 Lei
ADDRESS 1 /7o6 C. cir-.00
CITY/STATE/ZIP 5 6,,,, (/ 1 k, t.J 4 _
TELEPHONE NO. FAX NO.
PROPERTY ADDRESS it 7% C - /-60 LLOT NUMBER 2-s
SINGLE FAMILY DUPLEX ✓
u
METER(S) AND SIZE(S) REQUIRED / Sti'a -> her t... -.v. / 5'
IRRIGATION SYSTEM y 61 5
BACKFLOW ASSEMBLY 7',T� 10pv..,, s /s'o/%Ta,z
No fees apply (parts were provided by developer. Irvin has in stock, except duplex) Trench
excavation, pipe into house from meter setter and correct backfill provided by property owner.
A finish grade evaluation must be provided for meter box installation.
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