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2007, 04-02 Permit App: 07001038 Residence Project Number: 07001038 Inv: 1 Application Date: 04/02/2007 Page 1 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SFR W/ATT GAR Contact: VIKING CONSTRUCTION INC Address: 2605 W HAYDEN AVE C-S-Z: HAYDEN,ID 83835 Setbacks:Front 34 Left: 5 Right: 19 Rear: 77 Phone: (208)762-9106 Group Name: Site Information: Project Name: Plat Key: Name: Range District: East Parcel Number: 46353.5317 Block: Lot: SiteAddress: 5218 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: 12,880 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: y - pu _� v, ;� o , . ter , ,.._ .. ;�� �.oma. . Review Building Plan Review Released By: Driveway/Approach i Released By; Landuse/Zoning/HE Conditions [Released',By: 40,7 , „ay',ASWAN/Ar Sewer Review Released By: _' Permits: .� .>s NN _: ,.t ._. . ..4Fs .x_ x.4 gam-. _ '414', u,:s . ... .. Operator: JD Printed By: JD Print Date: 04/02/2007 Project Number: 07001038 Inv: 1 Application Date: 04/02/2007 Page 2 of 3 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 This Application: Total Project: Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation 1&2 FAMILY R-3 VB 1,350 $123,336.00 1,350 $123,336.00 BASEMENT U R-3 VB 1,320 $19,800.00 1,320 $19,800.00 COV DECK R-3 VB 20 $300.00 20 $300.00 DECK OPEN R-3 VB 96 $1,440.00 96 $1,440.00 GARAGE U-1 VB 686 $13,034.00 686 $13,034.00 Totals: 3,472 $157,910.00 3,472 $157,910.00 Item Description Units Unit Desc Fee Amount RESIDENTIAL PERMIT FEE 1 SELECT $1,318.55 WSBC SURCHARGE 1 SELECT $4.50 SF PLNS RVW<7999 SQ FT 1 SELECT $527.42 Permit Total Fees: $1,850.47 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 3 #OF UNITS $3.00 VENTILATING FANS 3 NUMBER OF $30.00 RANGE 1 NUMBER OF $10.00 HOOD-TYPE II 1 NUMBER OF $10.00 Permit Total Fees: $75.00 Operator: JD Printed By: JD Print Date: 04/02/2007 Project Number: 07001038 Inv: 1 Application Date: 04/02/2007 Page 3 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit 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 3 NUMBER OF $18.00 SHOWERS 2 NUMBER OF $12.00 TUBS 1 NUMBER OF $6.00 DISH WASHERS 1 NUMBER OF $6.00 GARBAGE DISPOSAL 1 NUMBER OF $6.00 CLOTHES WASHER 1 NUMBER OF $6.00 FLOOR DRAINS 1 NUMBER OF $6.00 MISCELLANEOUS FIXTURES 3 NUMBER OF $18.00 Permit Total Fees: $90.00 Notes: . :.. N , rr s .a,v,, na ._ .__.,_R.,_.MA , ,-:r.. nIr. _..M.... . ...d .. . ..__ Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Approach $50.00 $50.00 $0.00 $50.00 Building Permit $1,850.47 $1,850.47 $0.00 $1,850.47 Mechanical Penult $75.00 $75.00 $0.00 $75.00 Plumbing Permit $90.00 $90.00 $0.00 $90.00 $2,065.47 $2,065.47 $0.00 $2,065.47 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: JD Printed By: JD Print Date: 04/02/2007 0. SIPE PL A_\ ;i' .,,, 4 SCALE: 1"=20'-0" LOT 17 BLOCK 4 HUNTERS RUN SPOKANE VALLEY,WASHINGTON 5218 N.REES ROAD 80.00' \ - - - - - - - - - - - - - - - - - I ISAhPRO . ' This site plan is being submitted for the purpose of 1 obtaining a building permit and is a true and correct representaion of the propsal.All known property i line/dimensions,curb lines,structures and easements have been identified.Also indicated are wetlands, I bodies of water,steep slopes or other critical areas. Signed: Zi(1 ' MARVIN LOT AREA Date: `'- -.0Z 7 i 12880 1I I I 1 )( / 56'-0" / 19'-0" �, 1I 5'-0" / 12'-0" / I I 1 111111111 \ \ bi -- z- __- _ \ of of = - of °I = __-_ __- - _ -_ ,0_,I _ , SJP L Irl r� E� ,Jr�R y i SUB PANEL ( j -_ — - FOR ELECTRIC I O _- - - _ -__ f - __i±.-;:._ _ I =— CONC. I — = __ --_ - PORCH AND 1 lore SIDEWALK 1 PLANNING DEPT, APPROVE!)n By. „- • - i \ j DRIVEWAY I 10'UTILITY EASEMENT I DATE: ��� F- - ---------------------------------- SAILS UNDER r� W �, I GROUND m13'BORDER EASEMENT v) ,' i POKER I WALKWAY en 80.00' SWALE \ O — — ———— — — ----- — ----- — ----- 0 \ CURB FAIRCHILD ItEiES ao-n RIVERWOOD Project Number: 07001038 Inv: 1 Application Date: 04/02/2007 Page 1 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SFR W/ATT GAR Contact: VIKING CONSTRUCTION INC Address: 2605 W HAYDEN AVE C-S-Z: HAYDEN,ID 83835 Setbacks:Front 34 Left: 5 Right: 19 Rear: 77 Phone: (208)762-9106 Group Name: Site Information. Project Name: Plat Key: Name: Range District: East Parcel Number: 46353.5317 Block: Lot: SiteAddress: 5218 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: 12,880 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Building Plan Review Released By: Driveway/Approach Released By: Landuse/Zoning/HE Conditions t Released'By: Sewer Review Released By: Permits: _A :. ;.. .14e,F. .,. _ .o, 1`,447 Operator: JD Printed By: JD Print Date: 04/02/2007 Project Number: 07001038 Inv: 1 Application Date: 04/02/2007 Page 2 of 3 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 This Application: Total Project: Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation 1&2 FAMILY R-3 VB 1,350 $123,336.00 1,350 $123,336.00 BASEMENT U R-3 VB 1,320 $19,800.00 1,320 $19,800.00 COV DECK R-3 VB 20 $300.00 20 $300.00 DECK OPEN R-3 VB 96 $1,440.00 96 $1,440.00 GARAGE U-1 VB 686 $13,034.00 686 $13,034.00 Totals: 3,472 $157,910.00 3,472 $157,910.00 Item Description Units Unit Desc Fee Amount RESIDENTIAL PERMIT FEE 1 SELECT $1,318.55 WSBC SURCHARGE 1 SELECT $4.50 SF PLNS RVW<7999 SQ FT 1 SELECT $527.42 Permit Total Fees: $1,850.47 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 3 #OF UNITS $3.00 VENTILATING FANS 3 NUMBER OF $30.00 RANGE 1 NUMBER OF $10.00 HOOD-TYPE II 1 NUMBER OF $10.00 Permit Total Fees: $75.00 Operator: JD Printed By: JD Print Date: 04/02/2007 Project Number: 07001038 Inv: 1 Application Date: 04/02/2007 Page 3 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit 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 3 NUMBER OF $18.00 SHOWERS 2 NUMBER OF $12.00 TUBS 1 NUMBER OF $6.00 DISH WASHERS 1 NUMBER OF $6.00 GARBAGE DISPOSAL 1 NUMBER OF $6.00 CLOTHES WASHER 1 NUMBER OF $6.00 FLOOR DRAINS 1 NUMBER OF $6.00 MISCELLANEOUS FIXTURES 3 NUMBER OF $18.00 Permit Total Fees: $90.00 Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Approach $50.00 $50.00 $0.00 $50.00 Building Permit $1,850.47 $1,850.47 $0.00 $1,850.47 Mechanical Permit $75.00 $75.00 $0.00 $75.00 Plumbing Permit $90.00 $90.00 $0.00 $90.00 $2,065.47 $2,065.47 $0.00 $2,065.47 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: JD Printed By: JD Print Date: 04/02/2007 Permit Center Sf i r ne 11707 E Sprague Ave, Suite 106 1 P�R?�!iT PERMIT N�I.,MBER: t'�) 16 Jie Spokane Valley, WA 99206 rE�: (5091588-0036 FAX: C y De`` "rent, r,- »nk: alle nr4,.-9 ' �.�.y _tet, - _'t.__. I I Residential o sti ctipn y Tew Construction ❑ U rv., Bldgg. Permit Appl#`(itlan o Additian/Remodel o Deck 1{ ; liji " k:i '._, ❑ Other: SITE ADDRESS J41•.1. Pe Se I ASSESSORS PAARCEL NO: 46935.3 . C00 LEGAL DESCRIPTION: LL I I Ca_ 4 t-- -P ui Building owner Contractor _: Name: V k 6 (1.1 �1 Name: Address: �.(j U5 U. i a4 Address: City: I e4_11 Zip: D,�C7� City: Zip: Phone:` -11 ). gi0LFax: -X,G/1,th -Ligtsi , Phone: Fax: Lic No:V itl n(L1 5 IExp.Date: Contact Person: City Business Lic No: Name: Phone: Describe the scope of work in detail: Cost of Project: $ i-1( tro 1)\ s. **************The **************The following MUST be complete: (write N/A if not applicable)********************** HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: TOTAL HABITABLE SPACE: .g- —la ‘ Co K S(.... a'1<. MAIN FLOOR TO SQ. 2m' FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE FTG: 1 /3.� • /3 z.c� AREA: 3 ) -7 7 FINISHED BASEMENT GARAG SQ. FT''' OV. P — SQ. FTG: 30% SLOPES ON SQ. FTG: Off( "6 LTJLe. PROPERTY: /1I�� #OF BEDROOMS: CONSTRUCTION TYPE: HEAT SOURCE: SE\NrR OR SEPTIC? 3 N s Iv ik__ 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. _ ] Signature '�) 4 U-1'11.`l'� 81 L)LLU\C' Date 31�1 l Cfl Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash ❑ Check ❑ Mastercard ❑ ViSA ❑ Other Bankcard#: Expires: VIN#: Authorized Signature: REVISED 8.252005 F,.-..„,,,,,: . Stiokarte .-r=Y e ,__..„,„_ 11707 E Sprague Ave Suite 105 4 Spokane Valley WA 99206 509.921.1000 + Fax: 509.921.1008 4. cityheit@spokanevattey.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. O 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 wail 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 O Foundation plan O Insulation information • ,0r�� Permit Center Spokane 11707 E Sprague Ave,Suite 106 elley (5Spo09kane)688-0036 Valley,WAFAX:99206 (509)688-0037 °'Community Development wwwspokanevalley.ora.com e - � �.. � _a Mechanical Permit Application o Commercial a Residential SITE ADDRESS 5.:).1(e_..) H 'Re j P ( Building owner' i , . • Name: i�f 3)fl,; It Q \'1.CA l C. Phone: `( �..1 (la „inc., Fax (`CP' ,--)( t-5 t ) Address: , J� . LArt(,A City kailn State -1(.2( Zip fk ContractoC,.: Name: 1.4-ty" ,-,,ceh Phone: Fax: Address: City State Zip License No: City Business License No: Name: Phone: DESCRIPTION OF WORK i #OF UNITS X COST = TOTAL AMOUNT 1 FUEL BURNING APPLIANCE Equal to or less than 100,000 ` 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 1 X , $10.00 = 14 DRYER X $10.00 = 15 FUEL BURNING WATER HEATER X I $10.00 16 MISC.FUEL BURNING APPLIANCE X $10.00 = 17 GAS PIPING(each outlet) ] X $1.00 = 18 DUCT SYSTEMS X $10.00 = 19 VENTILATING FANS 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 ' X $10.00 = 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 = 26 AIR CONDITIONER 3-15 TON 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 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 CARD#: EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 8/26/05 • DEC 06 2005 09 30 FR TO 12087624507 P.01i01 Permit Center 11707E Sprague Ave,Suite 106 .000 , Spokane Vaney,.WA 99206 PERMIT NUMBER: ($09)688-0036 PAX:(509)688.0037 PER.mrr FSE: Coamunitytevelopmtnt K.,a,i,,,gazSllaV-ara.co_m PlumbPermit Application ❑ Commercial , 2f Residential SITE ADDRESS: j.)I C-';, �e'e s Enild1O:owner Nam= Q-(DLA Fax: . • On Phone: ''o- , l�� _-)(4.)..�-`t'�67 Address: ' City ,� - �+��� t.1 A state: "I II Zip: cV;'G"-� Condractor'. . . -—� Phone: Fax: Address: City: State: Zip: ^No: City Business License No: tvoat.ttt . ... • Name: Phone: DESCRIPTION OF WORK i OF UNITS X COST • TOTAL AMOUNT 1 TOILETS WATER CLOSET,BIDETS • X $6.00 = 2 URINALS _ X $6.00 = 3 TUBS - I X $8.00.- 4 SHOWERS(PER TRAP) _ BATH,STALL,ON-SITE BUILT J X $6.00 - LAVS/BASINS,BAR,FLOOR,KITCHEN, 5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 e X-RAY.FOOD,PREP/CULINARY MEAT 8 DISHWASHER I X $8.00 = 7 CLOTHES WASHER I X $8.00 - 8 GARBAGE DISPOSAL ( X *00 -T- 0 0 WATER SOFTENER X $8.00 - _ 10 ELECTRIC HOT WATER TANK NOTE: IF GAS.SEE MECHANICAL , X $6.00 - 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE J X $6.00 ROOF DRAINS/OVERFLOW _ 12 DRAINS X $6.00 le 18 FOUNTAINS,DRINKING X $8.00 • WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR, 14 VENT PLUMBING REVERSAL REVERSALS X $6.00 - 15 SEWAGE EJECTOR i GRINDER.SUMP PUMP X Se.00 • 16 WATER USING DEVICE ICE AN/OR COFFEE STEAMAKER,HOSE BIB. X $8.00 - PROOFER CARBONATOR.SWAMP COOLER VACUUM BREAKER.CHECK VALVE, 17 CROSS CONNECTION DEVICE AND R.P-B_P.D,FOR: VATS TANKS.BOILERS X $8.00 - 18 INTERCEPTORS GREASE TRAP,SAND TRAP, CHEMICAL HOLDING TANK _X $0.00 a 19 MEDICAL GAS(per outlet) NTROUs,OXYGEN X $8.00 MISCELLANEOUS PLUMBING 20 FIXTURE X $8.00 - 21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 INDUSTRIAL WASTE �T— = 22 INTERCEPTOR X. $15.00 METHOD OF PAYMENT; SUBTOTAL 0 CASH 0 CHECK 0 VISA ❑ MASTERCARD PROCESSING FEE $as.00 Card# EXPIRES: TOTAL PERMIT FEE DUE AUTHORIZED SIGNATURE: - REVISED WAS • ** TOTAL PAGE.01 ** C<'-I, r �I :: Permit Center PERMIT? ;?<IBER: L Q an 11707 E Sprague Ave, uite 106 \` iiey Spokane Valley, WA 99%06 PERMIT FEE: Community Development (c09)6Se-0036 r^nZ (509)6RR-0037 www.snokanevall ev:oro Approach Permit Application PROJECT ADDRESS )t ► -s START DATE ANTICIPATED COMPLETION DATE Building Owner: Contractor: Name: V Awn Name: yty-\_0 Address: at jS U j , y � , Address: City: ‘..e• -4.04,-\ State: Zip: City: State: Zip: Phone: �ir.3q1C�l Fax: .=1lola-_U4SC1 Phone: Fax: Contact Pcrson Contractor Lic No: Ex Date: Name: VIK1taC1i�1 p City Business Lic.No: Phone: r-'1rcr-ckt7t,, PROJECT DESCRIPTION(Provide site sketch) Residential Driveway Commercial/Industrial Driveway Existing Curb&Gutter Rural Road Section Culvert Installation Sidewalk Repan-/Construction Other Conditions Bond/Insurance certification must be 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 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. Signature ' �/ 1, ,�V�� L)Wx\ Date 3/ ) / 2 Method of Payment: ❑ Cash. ❑ Check ❑ Mastercard ❑ VISA Eankcard r: Expires: VIN#: .u;ho^Zed Signature: REVISED 3.910E