2003, 05-01 Permit App: BD03-215 Garage City of
SPOKANE VALLEY
•
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 OWNER etc-‘t pe( c k2 JOB LOCATION i Z 1(0 11 - Ce w (S
OWNER'S ADDRESS `.�aqr\ CITY r . PHONE ?Z --zL8e
DESCRIBE JOB C9&c p. e
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED K I
PARTNERSHIP f V/CORP. 7
BOX 2 CONTRACTOR'S NAME u ((el cn+c-Q c-t-vcS PHONE F__7_6 ' Z 5S
CONTRACTOR'S ADDRESS ZA 7 U q e On (f e CITY O I' sc.( 1 CO/c-(
CONTRACTOR'S REG.# U 4 CL F c /(f/KS EXPIRATION DATE j^Z-J( - -f
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT DSAS a. -e.y PHONE 7e ( 7 Z 961
ADDRESS CITY ZIP
BOX 4 SEWER AVAILABILITY SP)C C WATER AVAILABILITY l.a.c +F r
BOX 5 ESTIMATED PROJECT COST$ (0(Zia)(x) EXISTING BLDG. VALUATION$
BOX 6 PROPERTY TAX ACCOUNT NUMBER L( S(8 Z ,-cc S
LEGAL DESCRIPTION
1
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
f
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOORali,36 /S61/ (2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING G FT.
BOX 8 ( ) SINGLE FAMILY ( Ye) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE- 1 SQ. FT.
BOX 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.
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 PERFO;, • WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT CAA_ - w DATE S- ( -O_j (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 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
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. 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
DATE
ASSIGNED ADDRESS
11707 E. SPRAGUE, STE 106
SPOKANE VALLEY, WA 99206 .
(509)688-0036 FAX(509)688-0037 PROJECT TRANSMITTAL:
TRANSMITTAL DATE: 5//D
SITE INFORMATION PERMIT INFORMATION
Site Address: , L P i.t)i S Permit Number:Bo 03-)15 Issue Date: ,5-//d3
Permit Use: De-faG trek' 2( x 3 te 6;eivcicii
Parcel Number: r/ter'/ �5�.5 Applicant:
PP ULs i l ev
Subdivision: Q,,L e-ffctSO 1 FLOct( �—
Block: Li Lot: 7 ' s 0 cc Phone: qq0
Zoning: Lk(3,6 Water Dist: Contact:
Owner: 06 R , re -e. - ( ` Phone:
Address: � 2,cc, , Le w-15 Contractor:
Building Inspector: Bart n 1-4 Setbacks—Front: Left:(0Right: (e Rear:(
y
APPROVALS �
BUILDINGS: kill ,.,,_. . . r r - rari L.-
PLANNING:
-PLANNING: ► l • , .. .I
ENGINEERS: /2111fi, ..%
HEALTH:
SEWE :
DIST;
•
APPROVALS
WATER DIST
STO' ATER:
O'1'. R:
3C9 : (fkl
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°Z � a 43 � ZS
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SeGue,r
1216 N. LEWIS 46182.0526
130'
HOUSE
AJ.LOT 88. f I AJ. LOT
' 32'
N>
d.6' 0P
.
24'x36' 60'
.'
V 90'
AJ. LOT
APPROVED BY 711-L L w //l,?3