2003, 05-14 Permit App: BD-03-421 GarageCity of
SPOKANE VALLEY
PERMIT # adr203-y2�
BUILDING PERMIT APPLICATION
Box.1 OWNER Jt "7_. Wo1/
OWNER'S ADDRESS
DESCRIBE JOB
( 0037
k
1
JOB LOCATION
PHONE
Pey
THIS PROPERTY IS OWNED BY MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME Z �� �s PHONE 2,2,2 —/�nC)
CITY v -F, -e7 L /1-e
_
CONTRACTOR'S ADDRESS
CONTRACTOR'S REG.#
EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VE
BOX 3 CONTACT PERSON OF PROJECT L< 4Y 7/a17
ADDRESS l D��i/r�� �/ ����/// CITY
!RED)
PHONEP<
2-/`)
ZIP „.2G'
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST $
EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) q) Ut-t0
• CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing
3RD FLOOR / OTHER • /
BASEMENT UNFINISHED / DECK
CARPORT / TOTAL /
1ST FLOOR 2N&-F-OQOR
BASEMENT FINISHED /
/ GARAGE a �% / y A.
7‘.7
7
HEIGHT TO PEAK OF BUILDING FT.
30X 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
(EW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY
IMPERVIOUS SURFACE 8-7 6
SQ. FT.
SQ. FT.
3OX 9 PLUMBING FIXTURES (Including rough -ins) MECHANICAL APPLIANCES
PLEASE USE THE ATTACHED PLUMBING / MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SYSTEMS, HEATING AND AIR UNITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS,
LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL.
OX 10 Water Service meter size (if known) Also see BOX 4
OX 11 Septic Tank — Not generally allowed in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor and the Health District (See BOX 4)
OX 12 Street use may require a " Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
/ERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
DRRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
30VE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
JVNER/AGENT
DATE (OVER)
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 DEPARTMENTI,APPROVAL
REMARKS
DISAPPROVAL
DATE
PUBLIC WORKS DEFIRTMENT 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
BUILDING SQ. FT.
BUILDING SQ. FT. @ _
BUILDING SQ. FT.
BUILDING SQ. FT.
TOTAL SQ. FT. TOTAL VALUATION
BUILDING PERMIT NC. PLAN CHECK FEE REC'D RECEIPT NUMBER
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES ; I
BUILDING DEPARTM#TNT APPROVAL
BY
AMOUNT DUE
DATE
ASSIGNED ADDRESS
APP I pVE
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