2003, 05-14 Permit App: BD-03-419 GarageCity Of 003
SPOKANE VALLEY (Fay( &�I- U037
PERMIT # D D3 _L41 q }
BUILDING PERMIT APPLICATION
Box1 OWNER///t) 1ti1;��`% M� JOB LOCATION %& J, �'r
OWNER'S ADDRESS CITY t PHONE
DESCRIBE JOB
THIS PROPERTY IS OWNED BY: SINGLE/CARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME7�_ S+t PHONE j?
CONTRACTOR'S ADDRESS n'?(0 CITY
CONTRACTOR'S REG.# EXPIRATION DATE !
(CARD MUST BE PRESENTED AND COPIED OR VEF$IF
---------------- ______�------
_-
30X 3 CONTACT PERSON OF PROJECT '�" ' ��! PHONE
ADDRESS zoW CITY <-Od x
� c' �kj LAS + == - ZIP
30X4 SEWER AVAILABILITY �' -�
� �'� - WATER AVAILABILITY �O�
30X 5 ESTIMATED PROJECT COST $ A.T� _EXISTING BLDG. ALL;;ION $
3OX 6 PROPERTY TAX ACCOUNT NUMBER _ �aJf'
LEGAL DESCRIPTION ;
L9
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
OX 7 BUILDING SQUARE FOOTAGE (Existing/ proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT ! TOTAL / HEIGHT TO PEAK OF BUILDING
JX $ ( )SINGLE FAMILY � NEW CONSTRUCTION
( )MULTIFAMILY (NO. OF UNITS ) ( )EXISTING STRUCTURE
( COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY _SQ. F -I--
( )TENANT IMPROVEMENT IMPERVIOUS SURFACE _
)X 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:
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)X 10( )---------- Also see BOX 4
Water Service meter size if known
IX 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)
X 12 Street use may require a " Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
=RIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
RRECT TO THE BEST OF MY GE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
DVE PREMISES TO PERFOWTHEWORK FOR WHICH THE APPLICATION IS MADE.
NER / AGENTDATE (OVER)
I herebv authnr6+►.o ,�
---a --- -_ • kovnAUC v aiuey to cnarge the fee for thi
Visa Mastercard s permit to my credit card:
--- — — — — — — — — -- Expiration Date
Print the name of the Ilolder
n.
---- OFFICE USE ONLY_ PLEASE DO NOT WRITE BELOW THIS LINE
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ZONE_ SETBACKS: FRONT SIDE
REAR�_HEIGHT LIMIT
PLANNING DEPARTMENT APPROVALDISA �-
'
REMARKS
DATE
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENIl APPROVAL DISAPPROVAL
' DATE
REMARKS
PUBLIC WORKS DEMRTMENT 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
BUILDING DEPARTMENT APPROVAL
ASSIGNED ADDRESS
AMOUNT DUE
BY
DATE
APPROVED BY
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