2003, 05-13 Permit App: BD-03-396 Fireplacex-s3q-o(054
City of
SPOKANE VALLEY
PERMIT #
BUILDING PERMIT APPLICATION
(OW- 003
80037
Box 1 OWNER-DcM ti JOB LOCATION <7O 7 , /(1. 44/4-1* LA
OWNER'S ADDRESS CITY 5) a PHONE _22,(;):,2r...
c/
DESCRIBE JOB /40 S a / % cK4. ' 11-t k /_›/1 (7.'iE;
THIS PROPERTY IS OWNED BY: SINGLE X.
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME PHONE
CONTRACTOR'S ADDRESS CITY
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VEf IFIED)
L (uI-1-1 TC PHONE gn 22'72.(7
BOX 3 CONTACT PERSON OF PROJECT
ADDRESS 576 17 N, Mp4/ t/6. --ti CITY .5106 t'LO ZIP '(2.4
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST $ --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)
3RD FLOOR /
1ST FLOOR / 2ND FLOOR
OTHER - / BASEMENT FINISHED
DECK / GARAGE /
TOTAL / HEIGHT TO PEAK OF BUILDING FT.
BASEMENT UNFINISHED /
CARPORT /
30X 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY SQ. FT.
IMPERVIOUS SURFACE SQ. FT.
IOX 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
OX 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)
DX 12 Street use may require a " Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
/ERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
DRRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
30VE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
NNER/AGENT
DATE (OVER)
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
a
Visa Mastercard
--- ---- ---- ._--- Expiration Date
Print the name of the Folder
Signature
OFFICE USE ONLY - PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS: FRONT SIDE REAR
.__HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL
DATE
REMARKS
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
E 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