2003, 05-09 Permit: BD03-483 Siding City of 62W' 003(0
SPOKANE VALLEY fav (,,n,oo37
PERMIT # Q0o'3..k.ici3
B DING PERMIT APPLICATION
Box.1 OWNER 2(C tOtit C LE4Vlrr JOB LOCATION y OO S° -.ti/t) /126712 � -✓�
OWNER'S ADDRESS 4/oc% S S�ti� Y S/p,.F HONE -9/v
DESCRIBE JOB r - 1[/Q
THIS PROPERTY IS OWNED Y: SINGL ARRIED
PARTNERSHIP C RP.
30X 2 CONTRACTOR'S NAME E 1' )�-� (,J PHONE 2 7S
CONTRACTOR'S ADDRESS L37-7 7 A), 5, (4/4 ,9 CITY //.e5 r ,¢LL S` /4 5-58 57
CONTRACTOR'S REG. C(/j?t)2t Sup`�g�
# � �� EXPIRATION DATE T C/�� ‘C:_ c54-c)/ (CARD MUST BE PRESENTED AND COPIE OR VIFIED
30X 3 CONTACT PERSON OF PROJECT Cr-LE tai/k?-&-21_e,
PHONE 70(f Lf S 1-(,
ADDRESS / D } /ti• « ' Si CITY fe?C/it'rfu-S / ZIP g
lOX 4 SEWER AVAILABILITY
WATER AVAILABILITY
OX 5 ESTIMATED PROJECT COST$ 2' 0S-0 EXISTING BLDG.VALUATION$
,OX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
60. 25-
(IF NECESSARY, PLEASE SUB IT A SEPARATE PAGE WITH THE LEGAL DESCRIPTI• C�fdj��
• CENSUS NUMBER Jr)6.CD
LO NUMBER
DX 7 BUILDING SQUARE FOOTAGE ,Existing/proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTI4L / HEIGHT TO PEAK OF BUILDING • FT.
)X 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY(NO. OF UN TS ( ) NEW CONSTRUCTION
( ) COMMERCIAL/ INDUSTRI L ) ( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY SQ. FT.
-( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE_ II SQ. FT.
•
)X 9 PLUMBING FIXTURES (Including rough-ins) MECHANICAL APPLIANCES ,
PLEASE USE THE ATTACHED P_UMBING/MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SYSTEMS, HEATING AND AIR U\IITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS,
LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL
'X 10 Water Service meter size(if known) Also see BOX 4
X 11 Septic Tank-Not generall allowed in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor and t e Health District (See BOX 4)
X 12 Street use may require a" treet Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
=RIFY UNDER THE PENALTY OF PE JURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
RRECT TO THE BEST OF MY KNOW EDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
DVE PREMISES TO PERFORM THE ORK FOR WHICH THE APPLICATION IS MADE.
'NER/AGENT ,..,.�.�,
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 Holder
Signature
— — — — — —
- OFFICE USE ONLY-PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS: FRONT SIDE
REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
DISAPPROVAL DATE
REMARKS
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENII,APPROVAL
DISAPPROVAL DATE
REMARKS
-----------------^-_-
PUBLIC WORKS DEPARTMENT APPROVAL
DISAPPROVAL DATE
TYPE OF JOB: NEW RESIDENCE RES.ADD/ALT
NEW INDUSTRIAL IND.ADD/ALT
NEW COMMERCIAL _ COMM.ALT/ADD
NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADD/ALT
TENANT IMP. ROOF___OTHER
OCCUPANCY TYPE OF CONSTRUCTION
STORIES
I BUILDING SQ. FT. @ -
BUILDING SQ. FT. @ -
BUILDING SQ. FT. @ -
BUILDING SQ. FT. • @ -
TOTAL SQ. FT. TOTAL VALUATION
BUILDING PERMIT NO. PLAN.CHECK FEE REC'D
RECEIPT NUMBER
PERMIT FEE
PLAN CHECK FEE PLUMBING FEE
MECH. FEE
TOTAL FEES ,` WSBCC SURCHARGE ENERGY SURCHARGE
•
OTHER CHARGES
AMOUNT DUE
BUILDING DEPARTM,fNT APPROVAL . BY
•
DATE .
ASSIGNED ADDRESS
•