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2006, 11-16 Permit App: 06004496 Residence Project Number: 06004496 Inv: 1 Application Date: 11/16/2006 Page 1 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SINGLE FAMILY RESIDENCE,GAS,SEWER Contact: VIKING CONSTRUCTION INC Address: 2605 W HAYDEN AVE C-S-Z: HAYDEN,ID 83835 Setbacks:Front 34 Left: 5 Right: 6 Rear: 68 Phone: (208)762-9106 Group Name: Project Name: Site Information: Plat Key: Name: Range District: East Parcel Number: 46353.5315 Block: Lot: SiteAddress: 5122 N REES RD Owner:Name: VIKING CONSTRUCTION INC Address: 2605 W HAYDEN AVE Location::CSV HAYDEN,ID 83835 Zoning: UR-3.5 Urban Residential 3.5 Water District: 001 TRENTWOOD Hold: 111 Area: .00 Acres Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review In formation: Review Building Plan Review Released By: Originally Released: 11/16/2006 By: TMELBOU Driveway/Approach Released By: Originally Released: 11/16/2006 By: jlmain Landuse/Zoning/HE Conditions I Released By: Originally Released: 11/16/2006 By: cjjanssen Sewer Review Released By: Perm its: Operator: jmm Printed By: jmm Print Date: 11/16/2006 Project Number: 06004496 Inv: 1 Application Date: 11/16/2006 Page 2 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Approach Contractor: VIKING CONSTRUCTION Firm: VIKING CONSTRUCTION Address: 2605 W.HAYDEN AVE Phone: (208)762-9106 HAYDEN,ID 83835 Item Description Units Unit Desc Fee Amount APPROACH-CONST IN ROW 1 NUMBER OF $50.00 Permit Total Fees: $50.00 Building Permit Contractor: VIKING CONSTRUCTION Firm: VIKING CONSTRUCTION Address: 2605 W.HAYDEN AVE Phone: (208)762-9106 HAYDEN,ID 83835 Building Characteristics Total Area 1978 Building Height 19.5 Stories 1 Dwelling Units 1 Impervious Surfa 3898 This Application: Total Project: Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation 1&2 FAMILY R-3 VB 1,963 $169,544.31 1,963 $169,544.31 DECK OPEN R-3 VB 105 $1,575.00 105 $1,575.00 GARAGE U-1 VB 835 $15,865.00 835 $15,865.00 Totals: 2,903 $186,984.31 2,903 $186,984.31 Item Description Units Unit Desc Fee Amount RESIDENTIAL PERMIT FEE 1 SELECT $1,480.95 WSBC SURCHARGE 1 SELECT $4.50 SF PLNS RVW<7999 SQ FT 1 SELECT $592.38 Permit Total Fees: $2,077.83 Operator: jmm Printed By: jmm Print Date: 11/16/2006 Project Number: 06004496 Inv: 1 Application Date: 11/16/2006 Page 3 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Mechanical Permit Contractor: VIKING CONSTRUCTION Firm: VIKING CONSTRUCTION Address: 2605 W.HAYDEN AVE Phone: (208)762-9106 HAYDEN,ID 83835 Item Description Units Unit Desc Fee Amount GAS WATER HEATER 1 NUMBER OF $10.00 GAS APPLIANCE<=100,000BTU 1 NUMBER OF $12.00 GAS PIPING 4 #OF UNITS $4.00 AIR CONDITIONER:4-15 TONS 1 NUMBER OF $20.00 VENTILATING FANS 3 NUMBER OF $30.00 RANGE 1 NUMBER OF $10.00 HOOD-TYPE II 1 NUMBER OF $10.00 Permit Total Fees: $96.00 Plumbing Permit Contractor: VIKING CONSTRUCTION Firm: VIKING CONSTRUCTION Address: 2605 W.HAYDEN AVE Phone: (208)762-9106 HAYDEN,ID 83835 Item Description Units Unit Desc Fee Amount TOILETSBIDETS 2 NUMBER OF $12.00 SINKS 6 NUMBER OF $36.00 SHOWERS 2 NUMBER OF $12.00 TUBS 2 NUMBER OF $12.00 DISH WASHERS 1 NUMBER OF $6.00 GARBAGE DISPOSAL 1 NUMBER OF $6.00 CLOTHES WASHER 1 NUMBER OF $6.00 ROOF DRAINS 1 NUMBER OF $6.00 MISCELLANEOUS FIXTURES 3 NUMBER OF $18.00 Permit Total Fees: $114.00 Operator: jmm Printed By: jmm Print Date: 11/16/2006 Project Number: 06004496 Inv: 1 Application Date: 11/16/2006 Page 4 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Approach $50.00 $50.00 $0.00 $50.00 Building Permit $2,077.83 $2,077.83 $0.00 $2,077.83 Mechanical Permit $96.00 $96.00 $0.00 $96.00 Plumbing Permit $114.00 $114.00 $0.00 $114.00 $2,337.83 $2,337.83 $0.00 $2,337.83 Disclaimer: Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: _ Operator: jmm Printed By: jmm Print Date: 11/16/2006 Project Number: 06004496 Inv: 1 Application Date: 11/13/2006 Page 1 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project In formation: Permit Use: SINGLE FAMILY RESIDENCE,GAS,SEWER Contact: VIKING CONSTRUCTION INC Address: 2605 W HAYDEN AVE C-S-Z: HAYDEN,ID 83835 Setbacks:Front 34 Left: 5 Right: 6 Rear: 68 Phone: (208)762-9106 Group Name: Project Name: Site In formation: Plat Key: Name: Range District: East Parcel Number: 46353.5315 Block: Lot: SiteAddress: 5122 N REES RD Owner:Name: VIKING CONSTRUCTION INC Address: 2605 W HAYDEN AVE Location::CSV HAYDEN,ID 83835 Zoning: UR-3.5 Urban Residential 3.5 Water District: 001 TRENTWOOD Hold: ❑ Area: .00 Acres Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: _,m :�_ �� _ s. Review Flood Plain Released By: Building Plan Review Released By: Ak. t t t * Driveway/Approach Released By: Landuse/Zoning/HE ConditionsRel ease d,By: � Sewer Review j Released By: Operator: jmm Printed By: jmm Print Date: 11/13/2006 Project Number: 06004496 Inv: 1 Application Date: 11/13/2006 Page 2 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Approach Contractor: VIKING CONSTRUCTION Firm: VIKING CONSTRUCTION Address: 2605 W.HAYDEN AVE Phone: (208)762-9106 HAYDEN,ID 83835 Item Description Units Unit Desc Fee Amount APPROACH-CONST IN ROW 1 NUMBER OF $50.00 Permit Total Fees: $50.00 Building Permit Contractor: VIKING CONSTRUCTION Firm: VIKING CONSTRUCTION Address: 2605 W.HAYDEN AVE Phone: (208)762-9106 HAYDEN,ID 83835 Building Characteristics Total Area 1978 Building Height 19.5 Stories 1 Dwelling Units 1 Impervious Surfa 3898 This Application: Total Project: Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation 1&2 FAMILY R-3 VB 1,978 $170,839.86 1,978 $170,839.86 DECK OPEN R-3 VB 105 $1,575.00 105 $1,575.00 GARAGE U-1 VB 817 $15,523.00 817 $15,523.00 Totals: 2,900 $187,937.86 2,900 $187,937.86 Item Description Units Unit Desc Fee Amount RESIDENTIAL PERMIT FEE 1 SELECT $1,486.55 WSBC SURCHARGE 1 SELECT $4.50 SF PLNS RVW<7999 SQ FT 1 SELECT $594.62 Permit Total Fees: $2,085.67 Operator: jmm Printed By: jmm Print Date: 11/13/2006 Project Number: 06004496 Inv: 1 Application Date: 11/13/2006 Page 3 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Mechanical Permit Contractor: VIKING CONSTRUCTION Firm: VIKING CONSTRUCTION Address: 2605 W.HAYDEN AVE Phone: (208)762-9106 HAYDEN,ID 83835 Item Description Units Unit Desc Fee Amount GAS WATER HEATER 1 NUMBER OF $10.00 GAS APPLIANCE<=100,000BTU 1 NUMBER OF $12.00 GAS PIPING 4 #OF UNITS $4.00 AIR CONDITIONER:4-15 TONS 1 NUMBER OF $20.00 VENTILATING FANS 3 NUMBER OF $30.00 RANGE 1 NUMBER OF $10.00 HOOD-TYPE II 1 NUMBER OF $10.00 Permit Total Fees: $96.00 Plumbing Permit Contractor: VIKING CONSTRUCTION Firm: VIKING CONSTRUCTION Address: 2605 W.HAYDEN AVE Phone: (208)762-9106 HAYDEN,ID 83835 Item Description Units Unit Desc Fee Amount TOILETSBIDETS 2 NUMBER OF $12.00 SINKS 6 NUMBER OF $36.00 SHOWERS 2 NUMBER OF $12.00 TUBS 2 NUMBER OF $12.00 DISH WASHERS 1 NUMBER OF $6.00 GARBAGE DISPOSAL 1 NUMBER OF $6.00 CLOTHES WASHER 1 NUMBER OF $6.00 ROOF DRAINS 1 NUMBER OF $6.00 MISCELLANEOUS FIXTURES 3 NUMBER OF $18.00 Permit Total Fees: $114.00 Operator: jmm Printed By: jmm Print Date: 11/13/2006 Project Number: 06004496 Inv: 1 Application Date: 11/13/2006 Page 4 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Payment Summary• Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Approach $50.00 $50.00 $0.00 $50.00 Building Permit $2,085.67 $2,085.67 $0.00 $2,085.67 Mechanical Permit $96.00 $96.00 $0.00 $96.00 Plumbing Permit $114.00 $114.00 $0.00 $114.00 $2,345.67 $2,345.67 $0.00 $2,345.67 Disclaimer: Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: jmm Printed By: jmm Print Date: 11/13/2006 Permit Center C�v PERMIT?��U��iBEP.: Sone 11707E Sprague Ave, Suite 105 Valley Spokane Valley,WA 99206 PEPJ IT FEE: i ,11002500 (509)688-0036 FAX: (509)688-0037 Co i.r.71:,,a4y Development `.„T ...:ranevalev.ora,rnm ,. Residential Construction '...oit New Construction o Acccz,Nui y Bldg Permit Application '' 6 Additio emodeI't o Deck r- "i, p} ther: _ • SITE ADDRESS Q.1 V' 5t a L , l°1�.j -.- ASSESSORS PARCEL NO: J4 u33., 0` ( ) LEGAL DESCRPTION: �� I iA .c . .� .l_A eRi Contractor :. Building owner Name: VI�LI�` % l (l�.ClI Ctrl Name: Address: .lpp5 ‘ lel ` Address: City: W3)*ID Z4: b3b3r) City: Zip: Phone:40j1U,,,)-1iUtpFax:r`? - tea---U5 Phone: Fax: Lic NoN+V-l\le'itATExp•Date: Contact Person: . ; :----- :° City Business Lic No: Name: Phone: Describe the scope of work in detail: Cost of Project: $ Q Q .�)t ' **************The following MUST be complete: (write N/A if not applicable)********************** HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: TOTAL HABITABLE PAC : 19'-5'f 69' x 59' 1ANGNE6 j r? T i 6 MAIN FLOOR TO SQ. 2'V” FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE FTG: i9...7...„6.- .p / 3 N/A NM AREA: 3 898 FINISHED BASEMENT GARAGE SQ. FTG:, DECK/COV. PATIO SQ. FTG: 30% SLOPES ON SQ. FTG: lUU/A 8.4-7--.1(35 105 O 1K--, PROPERTY: �O #OF BEDROOMS: CONSTRUCTION TYPE: HEAT SOURCE: SEWER OR SEPTIC? 3 G on v. £as Foci A:r S� .( DISCLAIMER The permitee verifies,acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal,state or local laws, codes,or ordinances. 6) Plans or additional information may be required to be submitted,and subsequently approved before this application can be processed. - g. a ra' 1 1V1I Date l b I. Flo Method of Payment: (Faxed permit app ations will only be accepted with major bankcard) ❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other Bankcard#: Expires: VI Nit': Authorized Signature: REVISED 8 25,2005 ne _ -. Valley 11707 E Sprague Ave Suite 106 + Spokane Valley WA 99206 509.921.1000 + Fax: 509.921.1008 + cityhalt@spokanevalley.org Residential Plan Submittal Minimums ❑ Completed Building & Mechanical application with: Accurate address, Parcel Number and/or Legal Description, description of work, owner and contractor information, signature, and date. ❑ Two sets of plans including Site Plan, elevations, floor plans, foundation plans With details, roof plan, framing plans & details. ❑ Show the height of any proposed buildings or accessory structures. ❑ Floor plan for each floor: Dimension to scale (minimum 1/8") and label each Room (including sq. footage of house and garage on plans) Show each level of existing house and square footage of any additions. ❑ All braced wall panel types: show locations and details of installation, including engineered design. ❑ Egress windows: Provide at least one window or exterior door approved for Emergency escape or rescue from a basement and in every room for sleeping. ❑ Smoke detector locations ❑ 22" X 30" attic access location o 18" X 24" crawl space access: . ❑ One-hour separation detail: between house and garage ❑ Floor framing details: Joist type, size, spacing and installation details ❑ Roof framing plan and details ❑ Furnace and hot water heater location. ❑ All header locations: type, size, and connections ❑ Foundation plan 0 Insulation information DEC 06 2005 09:30 FR TO 12087624507 P.01i01 of,/`Sgokane � Permit Center �L f 11707 E Sprague Ave,Suite]06 PERMIT NUMBER: T q`{ .rte 1ailey Spokane Valley,WA 99206 (509)688-0036 FAX:(509)688-0037 Community Development w 24.col)4kanevall nry,c co n PERMIT FEE: Plumbing Permit Application ❑ Commercial Q Residential � SITE ADDRESS: _ 51 a t� Iy V / Bnildiog owner V; ' 1 '0� i i l-:I C (l l "1 I r ;"l Nano: j 1 i;, l Phone: r)I )1;,) CULL/, Fax: Li.;(�, --)lC._)-tet Address: '. l c i`-i L1 :1-A.C., . V,,,,„ t•-) I V%e _ City. /C c,I C'1,,/-) State: lZip: L -i ,-3r: Contractor = Name: � V Phone: Fax: ...... . ............ .. .. . . Address: _ City: State: Zip: --, License No: Cy Business License No: enii. ,.. Name: Phone: y DESCRIPTION OF WORT; a OF UNITS n COST N TOTAL AMOUNT in TOILETS WATER CLOSET BIDETS J.f $6.00 ©IENI =11 $8,00 © TUBS d ^ $6.00 111 SHOWERS PER TRAP BATH,STALL. ON-SITE BUILT 4� 1111 $6.00 111 I LAVS/BASINS,BAR,FLOOR,KITCHEN, SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, $G.DO X-RAY.FOOD PREP/CULINARY MEAT III `i' DISHWASHER MI $8.00 1111 7 CLOTHES WASHER =II $6,00 I © a GARBAGE DISPOSAL 36.00IIIIIIIIIIIII 9 WATER SOFTENER 111 $6,00 IIIE 10 ELECTRIC HOT WATER TANK NOTE: IF GAS SEE MECHANICAL 58,00 is FLOOR DRAINS AREA CASE COIt TRENCH CONDENSATE IIIIIIIIINIEI $6.00 ROOF DRAINS/OVERFLOW t DRAINS $6.00 IIIIIIIIIIMI FOUNTAINS DRINKING $6.00 IWATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR, VENT,PLUMBING,REVERSAL REVERSALS $8.00 SEWAGE EJECTOR GRINDER.SUMP PUMP © •6.00 III ICE AN/OR COFFEE MAKER,HOSE BIB, WATER USING DEVICE STEAMER 11111111 $6.00 IIIMI PROOFER CARBONAATOR.SWAMP COOLER 111 VACUUM BREAKER.CHECK VALVE, CROSS C•NNECTION DEVICE AND R.P.B.P.D,FOR VATS TANKS,BOILERS X $6.00 = GREASE TRAP,SAND TRAP, 16 INTERCEPTORS CHEMICAL HOLDING TANK $6.00 10 MEDICAL GAS ..r outlet NITROUS OXYGEN ii $8.00 r MISCELLANEOUS PLUMBING 20 FIXTURE X $6.00 II 21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 INDUSTRIAL WASTE - 22 INTERCEPTOR X $15.00 - SUBTOTAL METHOD OF PAYMENT: PROCESSING FEE II CASH ❑ CHECK 0 VISA ❑ MASTERCARD $35.00 Card# EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 6/76/05 -fih: TOTAL PAGE.01 ** Permit Center Spokane 11707 E Sprague Ave,Suite 106 PERMIT NUMBER:....JO Valley Spokane Valley,WA 99206 (509)688.0036 FAX:(509)688-0037 PERMIT FEE: Community Development www.sookanevallcy.oruz.com Mechanical Permit Application o Commercial Residential 5 VI ......-Ree' SITE ADDRESS 1�a Building owner Name: \ �t 1 \ i(u \ . 1 ,,. Phone: 't It, 1( Fax 1�1 ;,vi.‘ . IY;coo i {� �( f�� �,t -) � 1�I ,'��.�' � "-Ii�;� "l)�)( � Address: 1' I ►�. �(!� �!4 �t 11 i v\ (�I, I' Cityt )N i(-t;,,lEel Fax js�yZip ''t ',:4,(f.4.-i‘4.-i. Contractor Name: 1.1 t'' �lO.-.;t(- --1 Phone: Fax: Address: t' City State Zip License No: City Business License No: Contact . Name: Phone: DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT_ 1 FUEL BURNING APPLIANCE Equal to or less than 100,000 I X $12.00 = 2 FUEL BURNING APPLIANCE More than 100,000 X $15.00 = 3 UNLISTED APPLIANCE Additional Fee)__ Equal to or less than 400,000 X $50.00 = 4 UNLISTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 = 5 USED APPLIANCE(WSEC min.AFUE rating) Equal to or less than 400,000 X $50.00 = 6 USED APPLIANCE(WSEC min.AFUE rating) More than 400,000 X $100.00 = 7 BOILER/REFRIGERATION 1-100M BTU X $12.00 = 8 BOILER/REFRIGERATION 101 -500M BTU X $20.00 = 9 BOILER/REFRIGERATION 501-1,000M BTU X $25.00 = 10 BOILER/REFRIGERATION 1,001-1,750M BTU X $35.00 = 11 BOILER/REFRIGERATION More than 1,750M BTU X $60.00 = _ 12 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 = 13 RANGE I X $10.00 = 14 DRYER _ X $10.00 15 FUEL BURNING WATER HEATER I X $10.00 = 16 MISC.FUEL BURNING APPLIANCE ' 11i X $10.00 = 17 GAS PIPING(each outlet) r- X $1.00 = i 18 DUCT SYSTEMS X $10.00 = 19 VENTILATING FANS 1-5 X $10.00 = 20 AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 = 21 AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $15.00 = 22 EVAPORATIVE COOLERS X $10.00 = 23 TYPE I HOOD X $50.00 = 24 TYPE II HOOD I X $10.00 = 25 HEAT PUMP/AIR CONDITIONER 0-3 TON ii X $12.00 = 26 AIR CONDITIONER 3-15 TON II X $20.00 = 27 AIR CONDITIONER 15-30 TON X $25.00 = 28 AIR CONDITIONER 30-50 TON X $35.00 = 29 AIR CONDITIONER More than 50 TON X $60.00 = r-- 30 LPG STORAGE TANK X $10.00 = _ 31 WOOD OR PELLET STOVE/INSERT X $10.00 = 32 WOOD STOVE-FREE STANDING X $25.00 = 33 REPAIR&ADDITIONS X $15.00 = 34 VENTILATION SYSTEMS X $12.00 = 35 VENTILATION MECHANICAL EXHAUST X $12.00 = 36 INCINERATOR-RESIDENCE X $19.00 = 37 INCINERATOR-COMMERCIAL X $22.00 = METHOD OF PAYMENT: SUBTOTAL _ ❑CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00 _ #: EXPIRES: CARD TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 8n26/05 ., .,-:-..., ..... ...a ------- i'-1-n-i it C. en:et : ERI\'ITT .•..C.vriii17.1-1' t...D11.10.Kal.I t... i M-7 }-- '.:Iiit.- -.i . ,---- = \la L/(_- t,• SnAL--iiw Vaili.f.-, \..' -; 3Q20:=, 1 1 .S'i1I I ILL -z:10 ,-(! ' :!!'!--- ! , \ '-'.')(*'.l. .1)!..,3'-' -- - ':.:()InnhiriirV r..1:t\-4.:' rn"j 'Eli I' WV\. ,01,.5!1:.'‘ AD p ro a c:-1 P trmit A..;.)p 1 f_C a t i 0 11 , ..------, i PROFF(.71.A DDR AS ‘;i A 17;';'i:),-,'f Pt ,,,,I.4,ri-c,if,,,,,,TT j)c A.1/24F.1,-17:11 es7,1,) DA TE Building 1 OWIler: Contractor: .... — Name: U.ti---7, • ,----\--- I Name: .-•,.)1.1.ti-- N,6 1 _ ______ __.__ Address: 'NI -,-`.--- ‘, -, ,- • 7.7-- 17,7---------- Address: -J% c; , ) A ) 14.M1....LAR..-41113 " ' ' --...........- City: kli,,,L I 0, _ si.ate: 1:1- Zip: fc.:,..;?•,'(';:N cii . State: Zip: . Pli(me: tit'', -10-eit F2X: 1itl,) (.7.1S(1._._ Phone: Fait: . Contact.Person Name: .onti act oi Li c. No.v 1K II,v.,vire:211_1 Exp Date: _ City Business Lie.No: 1 _ Phone- •)(1.i.., ---1 •-•‘ c-i•-4 • ;-- .1, -•-•___L_L.,.-,--- At(.....z.L.,.. _____ ______ _____ ....._ — 1 6.. PROJEcif'DES(IR]PTI )N (Provide site sic et,.11) r fr--- Residential Driveway 1----- 1 (:::ointnercialitnclUSTria I Driveway (1 A!. E:xistingtel) GutterRural Road Section -----1 1- cf______,uivc.rt Installation Sidewalk Repair/Construction--- L......1 riothet.„..„,„„ions Bond/Insurance certification must he on file with the city. DISCLAIMER . The permittee verifies,acknowledges and agrees by their signatures that: 1) If this permit is for construction of Or on a dwelling,the dwelling is/will he served by pc)table water. 2) Owl:lc:I-ship of taus City of Spokane Valley Permit int ire to the property owner. 3)The signal oi y is the property Usenet or has pent fission io represent the property owner in this transaction. 1) All construction is to be done in full compliance with the City of Spokane Valley Development C:ode. Referenced codes are available for review at the City l of Spokane Valley Pet mit Center. 5) This City of Spokane Valley Permit is not a perrnit or approval for any violation of federal,state or k teal laws, codes or ordinances. 6) Plans or additional information may he required to he Submitted,and SLIbsequently approved before this application can be processed. S igira: re --i'7. A t.0,I\ \ 1.) Dare \ \-1 C., j 21,.(ezhoci of Pa V/14e7:1: 0 Cash il Check ill NI as:_ercard 0 VISA Pankcal-d : E):pire.:::: ',T.I•T4.: •o:.-ized Sigr;nrure: REV:SE.D:P5/0E