2003, 04-25 Permit App: BD-03-174 ReroofCity Of
SPOKANE VALLEY
PERMIT # BE) ()-2,- D q
BUILDING PERMIT APPLICATION
Box l OWNER! yFn k V�> ernice 6ondernwhJOB LOCATIONg-1 l& rQ cxyc.11
OWNER'S ADDRESS CITY PHONE
DESCRIBE JOB
THIS PROPERTY IS OWNED BY: SINGLE(M F-RIED_
PARTNERSHIP CORP.-
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BOX
ORP.______________________BOX 2 CONTRACTOR'S NAME S e ) �- PHONE
CONTRACTOR'S ADDRESS
CITY
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT PHONE
ADDRESS
CITY
- - -
IP
_____________________
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
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BOX 5 ESTIMATED PROJECT COST $ CC00 - 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 (-A SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS ) ( ) EXISTING STRUCTURE
( )
COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT.
-( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE _ SQ. FT.
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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 sizeif 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 WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/ AGENT ,c �� r� ,,,� DATE `I - r�� -0 3 (OVER)
46
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 QIP +.-
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OFFICE USE ONLY - PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS
DISAPPROVAL
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.
ILDING SQ. FT.
0
0
vo
TOTAL SQ. FT. TOTAL VALUATION
BUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER
PERMIT FEE AQAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES WSBCC SURCHARGE_ENERGY SURCHARGE
OTHER CHARGES AMOUNT DUE
BUILDING DEPARTMENT APPROVAL
ASSIGNED ADDRESS
BY
DATE 7 O