2003, 05-27 Permit App: BD-03-516 GarageY of 003 (0
OKANE VALLEY PX &", 0037
PERMIT # goo,?
BIJILDING PERMIT APPLICATION
I OWNER l,1,+1 a.. (,,, -,44 JOB LOCATION / ! d[ g EeAA 0, V_A t�
OWNER'S ADDRESS t- CITY PHONE
DESCRIBE JOB
THIS PROPERTY IS OWNED Y: SINGLE/MARRIED
PARTNERSHIP CORP.
2 CONTRACTOR'S NAME /44", ret --m-
-
CONTRACTOR'S ADDRESS kn S
ki
-----------._•----
_PHONE G % 0/0 e,
CITY
CONTRACTOR'S REG.# G4r0% "A-1?0 EXPIRATION DATE � -2�{- ou- 3
_ (CARD MUST BE PRESENTED AND COPIED OR VE IFIED)
3 CONTACT PERSON OF PROJECT r0^/ - PHONE
ADDRESS 7�
------------- CITY ��'�. ZIP gyp{
4 -SEWER AVAILABILITY WATER AVAILABILITY
5 ESTIMATED PROJECT COST $---- —___`
EXISTING BLDG. VALUATION $
---------------
5 PROPERTY TAX ACCOUNT NUMBER -
LEGAL DESCRIPTION
p
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBERI
L NUMBER
BUILDING SQUARE FOOTAGE JExisting /proposed) 1ST FLOOR •r7C' 2ND FLOOR.— t-=
3RD FLOOR `T --
BASEMENT UNFINISHED
CARPORT ! TOT
( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UN
( Y COMMERCIAL / INDUSTRI,
( )TENANT IMPROVEMENT
PLUMBING FIXTURES (Includit
PLEASE USE THE ATTACHED
SYSTEMS, HEATING AND AIR
LAWN SPRINKLER SYSTEMS,
OTHER _ / - BASEMENT FINISHED . .
/ DECK / GARAGE /
---/ HEIGHT TO PEAK OF BUILDING
NEW CONSTRUCTION
FT. .
— 1 ( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY Q. FT.
IMPERVIOUS SURFACE SQ. FT
agh-ins) MECHANICAL APPLIANCES
UMBING / MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
ITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS,
CK FLOW PREVENTERS, ET AL-.
=------------------- - jl
Water Service meter size Of known)
Also see BOX 4
Septic Tank - Not generally allowed in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor and tie Health District (See BOX 4)
Street use may require a " Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
( UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME 1S TRUE AND
:T TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OVER OF THE
PREMISES TO PERFORM THE WORK FOR WHICH THE AP.PLICA7ION IS MADE.
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 $older
OFFICE USE ONLY - PLEASE DO NOT ----- LIN-_'----
OT WRITE BELOW THIS E
ZONE SETBACKS:" FRONT SIDE
—_
PLANNING DEPARTMENT APPROVAL R�R�--HEIGHT LIMIT
DISAPPROVAL
REMARKS DATE
SEPA:-EXEMPT --= '• NOT EXEMPT
FIRE DEPARTMENT IPPROVAL
-
DISAPPROVAL
REMARKS
DATE
PUBLIC WORKS D EdARTMENT
APPROVAL
DISAPPROVAL
DATE
TYPE OF JOB: NEW RESIDENCE
____ _RES, ADD/ALT _--__-
NEW INDUSTRIAL
NEW COMMERCIAL . '
--- T —IND. ADD/ALT
COMM. ALT/ADD
'
NEW MULTIFAMILY
MULTIFAMILY ADD/ALT
—NO. UNITS —�-
TENANT IMP. .__
ROOF__OTHER
OCCUPANCY
TYPE OF CONSTRUCTION
STORIES
-----------4--BUILDING SQ. FT.
@
BUILDING SQ. FT.
@
BUILDING SQ. FT.
@ -
BUILDING SQ. FT.
@ -
TOTAL SQ. FT.
TOTAL VALUATION .
BUILDING PERMIT N PLAN. CHECK FEE RECD
RECEIPT NUMBER
PERMIT FEE -
PLAN CHECK FEE PLUMBING FEE
MECH. FEE _
TOTAL FEES — WSBCC SURCHARGE
__ENERGY SURCHARGE •
OTHM CHARGES '
AMOUNT DUE
BUILDING DEPARTMjgNT APPROVAL BY
DATE
ASSIGNED ADDRESS
to
S 2a
�t s
� N
'ERMIT SITE PLAN
ROJECT NO.: r
,egal Description:
)wner:
:esidenti OR
,,ommercial STREET
ence Certificate Required?
YES NO
)eveloper Services:
-,onin : APPROVED BY
'5ITE ADDRESS:
Line
HOUSE
FRONT
6eweT M-eactowS
A/L
STREET
tAus'f Nalow 4wr,
s
55' fiv.- Q p
`j
t,J1.�cl.
)ye,o e �-
6eweT M-eactowS
A/L
STREET
4
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