2003, 06-24 Permit App: BD-03-698 RemodelCity of
SPOKANE VALLEY
Phone
FAX
Inspection
PERMIT # IV t "
BUILDING PERMIT APPLICATION
688-0036
688-0037
688-0054
Box 1 OWNER V i R A k- 0 I% JOB LOCATION
OWNERS ADDRESS (;,/ Lior/ s. kE6S Le. CITY 11.&raofa?e ST. WW PHONE ()927- e/351.7
DESCRIBE JOB
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED 2C PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME PHONE
CONTRACTOR'S ADDRESS CITY
CONTRACTORS REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
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)
3RD FLOOR / OTHER /
BASEMENT UNFINISHED / DECK
CARPORT / TOTAL /
1ST FLOOR /
2ND FLOOR /
BASEMENT FINISHED
/ GARAGE
HEIGHT TO PEAK OF BUILDING
FT.
BOX 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.
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 TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER / AGENT DATE C �--0 J (OVER)
s-vappbp 4-16-03
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 Bolder Signature
DO NOT PLACE ANY BUILDING UNDER POWER LINES OR OVER INCOMING GAS LINES.
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. @ =
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
AMOUNT DUE
OTHER CHARGES
BUILDING DEPARTMENT APPROVAL
BY
ASSIGNED ADDRESS
Received
DATE
CITY OF SPOKANE VALLEY
BUILDING DEPT.
PERMIT NUMBER C} / e S — ‘.76.
ADDRESS `� / 5 f et S Lh
PLANS FOR
OWNER //gra I p i 61./
DATE SUBMITTED C4 tiD TE APPROVED 4/v
APPROVED BY
h
ECEMED
JUN 2 4 2003
CUALIDION
CITY COPY
EXHAUST FANS
100 CFM kitchen
50 CFM bathrooms
& laundry
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ucnrecc windows/openable