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2014, 11-19 Permit App: BLD-2014-2803 ResidenceSpokane .••Svalley Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (509) 720-2540 Fax: (509) 688-0037 permitcenter@ sookanevaIlev.ora F (Staff Use Only) PERMIT NUMBER: PERMIT FEE: RESIDENTIAL CONSTRUCTION PERMIT Appdaiii&P ® NEW CONSTRUCTION ❑ DECK ❑ ADDITION/REMODEL ❑ OTHER SITE ADDRESS: 4/5" ,E guc««S f Pt. ASSESSORS PARCEL NO.: BUILDING OWNER NAME: ❑ ACCESSORY B#DING PERMIT CENTER LEGAL DESCRIPTION:Av tirccC NAME: Mort (0/10iruCiinr ADDRESS: �15� 14/ 13..//4.r•vL CITY: Cil; 1, r c PHONE: ata. 777. 3,b CONTACT NAME: 14 -rem,/ 4n• S✓o }C STATE: ,.x- 0 zIP: 33 FAX: CELL: V A'c r PHONE: p208, 66 C • cc/3 FAX: CELL: CONTRACTOR NAME: MAILING ADDRESS:pr7 a CITY: COLue �ILRG La7J'!Fr✓G/. 0,7 71 So 14). 11ikr,,,, Ln . Sljii< *NT PHONE: fib,. 77'7. 3000 CONTRACTOR LICENSE No.: STATE: _To \ ZIp: 732m FAX: CELL: -071 74/0 EXPIRES: CITY BUSINESS LICENSE NO.: %%C'fJ f $ ?7 C7 DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE: S; )IL j-(_ ****YOU MUST COMPLETE THE FOLLOWING**** MARK N/A IF NOT APPLICABLE Height to Peak: 76 iloor Dimension: 3O X62 No. of Stories: ,,Z Total Habitable Space: , %o ;c?/ Main SQ FT: ii60 y rt Upper Floor SQ FT: ., Unfinished Basement SQ FT: Finished Basement SQ FT: //6.,0 4 Al Garage SQ FT: I0/0 Deck/Covered Patio SQ FT: lf9(7 Impervious Surface Area: 30% Slopes on Property: No. of Bedrooms: 4/ Construction Type: V U Heat Source: 6;,--A Sewer or Septic: $+ r TOTAL COST OF PROJECT: $ /60,600 DISCLAIMER The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction 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) The 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 submi wird suJ quently approved before this application can be processed. Signature Date: a q fg Updated 1-11-11 C:\Users\levi\Downloads\Res_Permit.doc Page 1 of 1 Project = 2014 SEWER PERMIT APPLICATION Spokane County Division of Utilities Phone: (509) 477-3604 Fax: (509) 477-4715 This application form must be filled out accurately and in its entirety and signed or a permit will not be issued tfit 12&11fit sha be issued per Application. Sewer permits are valid for 12 months from the date issuance. First time contractors or home owners performing the installation must receive orientation/consultol it)itpur f-pieti4�4..!?E� Utilities Division. CIV I Homeowner Installations: I agree to have consultation prior to performing any work. I S U B 4 '901-PS03 RECEIVED INSTALLER'S INFORMATION (PLEASE PRINT) Contractor (company Name): Arrow Excavation State License Number: Business Address: _11741 W Roman Rd. _ Name: Tom Mort Phone: 208.929.1830 City/State/Zip: Post Falls, ID. 83854 ArrowE1055DF PROJECT INFORMATION (PLEASE PRINT) Job Address: 11615 E. Rivercrest Dr. Parcel Number: Lot: 5 Block: Project/Plat Name: Rivercrest @Coyote Rock Owner's Name: Mort Construction 2 Address: 1950 W. Bellerive Ln. Suite #107 City/State/Zip: Coeur d'Alene ID. 83814 Phone: 208.7773000 CHECK APPLICABLE BOXES til Connection to Sewer ❑ Dry Side Sewer ❑ Repair ❑ Alteration to Existing Sewer ❑ Abandonment ❑ Main / Manhole Tap/Cut-In Xi New Construction NI Residential ❑ Commercial ❑ Temporary ❑ Accessory Building ❑ Trap / Separator ❑ Private Sewer Extension (no building connections) Other INTERIOR PLUMBING ALTERATIONS Yes 0 No 0 (All interior plumbing and electrical work requires separate permits.) Plumbing Contractor Name: Phone: WORK TO BE PERFORMED IN OR FROM THE PUBLIC RIGHT-OF-WAY 0 Yes 11 No If yes, a separate permit to work in the right-of-way is required from the ap • .. a e aaggee)c . APPLICANT JeremyVoeller SIGNATUR J _ �(�//(%DATE: _ (Please Print) Owner or Contractor (circle one) FEE CALCULATION - to be completed by the Division of Utilities Each Land Parcel connecting to the sewer must have a separate permit. One permit fee is required per building connecting to the sewer. Exception: Connection of accessory buildings as defined under SCC 8.03.6040(0 may be included under the permit applica- tion and fee for the primary structure. Additional inspection charges may be applicable per SCC 8.03.60.J0(a). Number of buildings connecting to sewer: Number of Sewer Main/Manhole Taps: Private Sewer Extension / Dry Side Sewer Repairs, Alterations, Abandonments & Other Add'! fee for Weekend/Holiday Inspection 1 X $125 permit fee = $ 125 X$125 tap fee =$ X $125 permit fee = $ X$125 permit fee =$ X $100 permit fee = $ + $ 26.64 Application Fee Total Permit Fee = $ 151.64 ****Applicable GFC, SCC, CFR, or Latecomer Fees may be due prior to issuance of a Sewer Permit.**** UTILITIES CONTACT SIGNATURE: DATE: Special Permit Conditions: Bankcard Number: Foran Rev. Date 11/13/13 METHOD OF PAYMENT 0 Cach ❑ Check Visa REDACTED Authorized Signature: ❑ MasterCard Ex PL ❑ Discover Dais SE EMAIL RECEIPT i 'l C) teremv@+bur This document originally contained confidential credit card information which was redacted pursuant to RCW 19.255.010 and the original document destroyed pursuant to SOS DAN GS2014-030.