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.