2003, 04-18 Permit App: BD-03-126 RemodelCity Of
SPOKANE VALLEY Q
PERMIT # g 1> 4 3" 1 2
BUILDING PERMIT APPLICATION
Box 1 OWNER 4 �iZ,'s JOB LOCATION
OWNER'S ADDRESS CITY PHONE
/313
DESCRIBE JOB 4' /d 2�/ rc��:,,
THIS PROPERTY IS OWNED BY: SINGL ARRIO
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME PHONE
CONTRACTOR'S ADDRESS
CITY
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
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BOX 3 CONTACT PERSON OF PROJECT PHONE
ADDRESS
CITY
ZIP
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) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING FT.
BOX 8 SINGLE FAMILY NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS ) ( ) EXISTING STRUCTURE
( )
COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE 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.
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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 TO PERFORM THE FOR WHICH THE APPLICATION IS MADE.
OWNER / AGENji�'_ .--'i='� DATE (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
OFFICE USE ONLY - PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS: FRONT
PLANNING DEPARTMENT APPROVAL
REMARKS
SIDE REAR
DISAPPROVAI
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS
HEIGHT LIMIT
DATE
ISAPPROVAL DATE
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
BUILDING PERMIT NO.
PERMIT FEE
TYPE OF CONSTRUCTION STORIES
BUILDING SQ. FT.
BUILDING SQ. FT. @
BUILDING SQ. FT.
BUILDING SQ. FT.
TOTAL SQ. FT.
I
PLAN CHECK FEE RECD
PLAN CHECK FEE
TOTAL FEES WSBCC SURCHARGE
OTHER CHARGES
BUILDING -DEPARTMENT APPROVAL
ASSIGNED ADDRESS
TOTAL VALUATION
PLUMBING FEE
RECEIPT NUMBER
ENERGY SURCHARGE
EM
MECH. FEE
UNT DUE
DATE
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