2003, 10-03 Permit App: BLD-03-02669 Tear Off, Reroof P. 3
MAR 28 2003 14:09 FR TO 5320893 P.02/02
BOX 10 WATER SERVICEMKTSR SIZE(IF KNOWN) (ALSO SEE BOX 4)
BOX!1 SEPTIC TANK-NOT GENER•T•T•Y ALLOWED IN THE CITY OF SPOKANE VALLEY. FOR
SPECIAL CIRCUMSTANCES CONTACT THE SEWER PROVEYOR AND THE HEALTH
DISTRICT. (5EE BOX 4)
BOX 12 STREET USE MAY REQUIRE A"STREET USE PERMIT'FOR SEWER,WATER,SIDEWALKS,
SIDEWALKS,CURB CUTS.CONTACT THE PUBLIC WORKS DEPARTMENT.
t VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF 7HE
ABOVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER IAGENT DATE
OFFICE USE ONLY-PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS: FRONT SIDE REAR HEIGHT UMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
SEPA EXEMPT NOT EXEMPT
-__—__-•____..-----=aa-- _=____�----_—_�za=-=ramaaroc=a=-_-
FIRE DEPARTMENT APPROVAL DISAPPROVAL DATE
PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE
TYRE OF JOB: NEW RESIDENCE RES.ADD/ALT NEW INDUSTRIAL IND.ADD/ALT
NEW COMMERCIAL COMM.ALT/ADD NEW MULTIFAMILY NO.UNITS
MULTIFAMILY ADDiALT TENANT IMP. ROOF OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORIES
BUILDING SO.FT.
SQ.FT. a
SO.FT --- ®
-— SO FT. a _
// 7-2- -
.�
TOTAL SQ.FT. TOTAL VALUATION (R 1 0 -2- -
suit DING PERMIT NO. PLAN CHECK FEE RECD RECEIPT NUMBER
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH.FEE
TOTAL FEES-. WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES AMOUNT DUE
BUILDING DEPARTMENT APPROVAL BY
ASSIGNED ADDRESS
RECEIVED ACCEPTED FOR FILING
*> TOTAL ?AE.02 *•.
PAGE.03
SEP 28 2003 14:08