2003, 06-02 Permit App: BD03-253 ResidenceI I R [ECENWE D
City Of JUN 0 4 2003 (�,��- oo3CP
SPOKANE VALLEY °003`%
°dx
BUILDING PERMIT APPLICATION
Box 1 OWNER .� ILIZ $•v0
• =s,4e vr-, i_ "_Fa tm JOB LOCATION Z&>5"A%. �/pyyU.yjX/Ci
OWNER'S ADDRESS />/ili/ .al 4WITY ,C,'W4PHONE
_g%25% meq, Z tWs--
DESCRIBE JOB cwt/,0 - ,4cxm 13f.,Q/ZOoril ?"GcJO T3��ll� c?s+rOGGE/GT—
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED I
PARTNERSHIP CORP.,�p�,e,T
BOX 2 CONTRACTOR'S NAME —�„oa eofpoe SpGF, %4FOftf4 PHONE_ 4-%o.4-%o.6,o
CONTRACTOR'S ADDRESS /O 15- �J. j ,r/pi>q CITY C�/,tOi,�,�,r/��
CONTRACTOR'S REG.# qac g 2� :FAD EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
_________
BOX 3 CONTACT PERSON OF PROJECT,Z� PHONE
ADDRESS /alp CITY._,pGV(c�i�J� ZIP_
BOX 4 SEWER AVAILABILITY - WATER AVAILABILITY
-------------
BOX 5 ESTIMATED PROJECT COST $ f?>_ Z �/, oo EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
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 /Z,Ze6
2ND FLOOR T=
3RD FLOOR — OTHER BASEMENT FINISHED
BASEMENT UNFINISHED --7-- DECK GARAGE
CARPORT -/ TOTAL / 2 2 2C� HEIGHT TO PEAK OF BUILDING
- .4_ FT.
BOX 8
SINGLE FAMILY (�() NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS ) ( ) EXISTING STRUCTURE
( )
COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY ,a S' SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE _
_---------------------------- ------ SQ. FT.
30X 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.
,OX 10 Water Service meter size (if known)-----
Also see BOX 4
lox 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)
OX 12 Street use may require a ” Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
ORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
BOVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
WNER /AGENT ! DATE /� 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 Ilolder
OFFICE USE ONLY - PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS: FRONT SIDE
PLANNING DEPARTMENT APPROVAL
REMARKS
REAR______HEIGHT LIMIT
DISAPPROV
DATE
SEPA: EXEMPT NOT EXEMPT
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.
BUILDING PERMIT NO.
19
8
PLAN CHECK FEE REC'D
TOTAL VALUATION
RECEIPT NUMBER
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES , WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES I AMOUNT DUE
BUILDING DEPARTMffNT APPROVAL
DATE
ASSIGNED ADDRESS
City of SPOKANE VALLEY
CERTIFICATE OF WATER AVAILABILITY
APPLICANT'S NAME gEel�oilZ�
LOCATION (ADDRESS)_Z �' opal
PROPOSED USE 25F/2
PHONE NUMBER
Water requested: Number of residential taps or commercial flow of GPM.
(Attach map or legal description, ifnecessary)
Building Permit _ Short Subdivision Rezone or other Preliminary Plat or PUD
FIRE DEPARTMENT REVIEW
Water is / or will be available at the rate of flow and duration indicated below at no less than 20 psi
measured at the nearest fire hydrant which is feet from the building / property above (Or as marked
O on the map attached).
Rate of flow Duration
Less than 500 gpm (approx. gpm) Less than one hour
500 to 999 gpm 1 hour to 2 hour
1000 gpm or more 2 hours or more
Calculation of gpm (Commercial building permits require a flow test or calculation)
Flow test of gpm
Water system is NOT capable of providing fire flow.
Fire flow is satisfactory Fire flow is NOT satisfactory
Fire District Signatory name
Date of Signature
PURVEYOR NAME ]i(/ W
Purveyor's Address /
Telephone Number or
WATER PURVEYOR INFORMATION
1. a. Water will be provided by service connection only to the existing inch
water main feet from the site.
OR b, Water service will require an improvement to the water system by the contractor of:
_ (1) feet of water main to reach the site; and/or
_ (2) the construction of a distribution system on the site: and/or
(3) other (describe) elimination of temporary water services through District
participation, which will require a public hearing.
2. a. — The proposed project is consistent with the water purveyor's DOH approved water system
plan.
b. The water system has a current Washington Department of Health Operating permit,
allowing the number of new taps or water requested.
COMMENTS I CONDITIONS
I hereby certify that the above water purveyor information is true. This certification shall be valid for one year
from the date of signature.
Agency (District) name
Signatory name
Title Signatory date