2011, 02-07 Permit App: 11000300 Remodel Community Development Department (Staff Use Only)
Permit Center /�
11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER: I I no
CITY OF 101111"\Spoliane Spokane Valley, WA 99206
Tel: (509) 720-2540 PERMIT FEE: l( 1171-
Valley
Fax: (509) 688 003.010o7
�2ern7it 7,,,!�, },c kanwaIiey.gry
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
0 NEW CONSTRUCTION U. ADDITION/REMODEL 0 ACCESSORY BUILDING
0 DECK 0 OTHER
SITE ADDRESS: 2-5M5-5 E L X\i ( V c 2 S(1
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: \` C ( ,1 i j 'PA•Ei 13 A..
NAME: sS ‘,vv . (A L.-VVl C k OA
ADDRESS: 2_5-1 S 5 L) )4 ;U E.:2 i—y
CITY: S 1.-)b 1C/A 6\-)tr 11 n j_t_(. v STATE: LA3 J ZIP: ?920()720cj
PHONE: 5-06/ ,- C:(2 7 - -7 40-1 FAX: CELL:
CONTACT NAME: 1\1 tck-,7 A jk j SC O `
PHONE: `� !d ` / g� � `--4 LI FAX: CELL:
CONTRACTOR NAME: VI\L-06 1? 0 c v,.i.5 i 2.:L-ttoe.) L-.L.c--
MAILING ADDRESS: 1 i 0(a 1.4 1`( vvl (L'-t A)
CITY: <.j 17 p(�A,✓li c' STATE: W I ZIP: `/ c(2 07
PHONE: (.. "1.),ci > 9c/`)) - J :, c 5' FAX: CELL:
CONTRACTOR LICENSE No.:VAL"..-:Pcc1 i'. K e( EXPIRES: CITY BUSINESS LICENSE NO.: (d Z 12 l/
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
f3''t1-H✓Lts;uk. 12e_,i.. ,p6 z. i ,2,'-AL, uL, 4L -( c 12---- ,3 i:: ' F.-,2e� e,
,u .
1- �
/oor w, ei n.- i
k ,ity/, /dam, ) - rive.- 1 /I/7L/r ke p 1� IP5•ae�-
G/''k/4%' "194/1ry ****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICABLE
Height Peak: Dimensions: No.of Stories: Total Bab'
��([ Z. Space:
Main 10 FT: Uppe#ltio 4 FT: Unfinis Basement SQ Finished Bay� ent SQ
FT: / FT: i1 '
Garage T: Deck/Cov Patio SQ Impe sous urface 30%Slopes
t7N/ FT: Area: / Property:
No. of ed ms: Z Constru ion Type: ,�(/,� Heat Source: _ 4S Sewer or Septic. i..,c,
TOTAL COST OF PROJECT: $ i `? T1 , S-
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 regyi ei to be submitted and subsequently approved before this application can be processed.
(76.----w
Signature(' , _-- Date: 2.1-7/Z(ti t(
Updated 1-11-11 Page 1 of 1
C:\Users\Nathan\AppData\Local\Temp\Building_Permit_-_Residential_11-11-11.doc
Permit Center
06 of 11703 E Sprague Ave,Suite B-3 PERMIT NUMBER:
Spokane Valley,WA 99206
.0.0Vah ey (509)688-0036 FAX:(509)688-0037 PERMIT FEE:
jiCrill rn rrtr rukare‘all inti
Community Development
Plumbing Permit Application ❑ Commercial KI Residential
SITE ADDRESS: Z-515- S. 4'
Building Owner
Name: A L wE i Phone: (. 1N2? 1 Lityq Fax:
Address: Ci �'— State: t.,-: Zip: Ct2
LSI( s �:.�[rvc -zsr} y y: 'S?Oen.ctE %✓ �?
Contractor
Name:immeriz Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact/Project� Manager: �y
Name: Arm �J Phone: 5ZjC1 — !?' — 6 y
#OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
URINALS
TUBS
SHOWERS(per trap) '[
Lav/Basins,Bar,Floor,Kitchen,Laundry,Utility,Janitor,Photo,X-ray,Food,
SINKS Prep/Culinary Meat
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN Area,Case,Coil,Trench,Condensate
ROOF DRAIN/OVERFLOW DRAINS
FOUNTAIN,DRINKING
WATER PIPING/DRAIN-IN WASTE Installation,Alterations,Repair,Reversals
WATER USING DEVICE Ice and/or Coffee maker,hose bib,steamer proofer,carbonator,swamp cooler
PRIVATE SEWAGE DISPOSAL SYSTEM
WATER HEATER If Gas,See Mechanical
INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS Including traps,vents except kitchen type grease interceptors functioning as fixture traps
REPAIR OR ALTERATION Water piping,drainage or vent piping
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE Other than atmospheric type vacuum breakers
MEDICAL GAS
INCEPTORS
❑CASH 0 CHECK 0 VISA 0 MC EXPIRES:
Card# VIN:
SIGNATURE:
P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg.doc