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2003, 04-17 Permit App: BD03-116 Egress Window City of SPOKANE VALLEY PERMIT # £to-,3 '-/ Le BUILDING PERMIT APPLICATION Box 1 OWNER 4x) rel:rW,fM JOB LOCATION /3602/ OWNERS ADDRESS Sen—l< CITY PHONE DESCRIBE JOB j4!?7i= lsU Ze_ G4.49-# THIS PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME PHONE p6-30/F CONTRACTOR'S ADDRESS /`77e2"-/ E_ geo/9)4,I CITY g�_,sr/s9C.F' 3 ' CONTRACTOR'S REG.# *4-4_ #T MUST BE EXPIRATION DATE �A7/2-0493 (CARD PRESENTED AND COPIED OR VERIFIED) BOX 3 CONTACT PERSON OF PROJECT ©hamT 5 v cchr PHONE 9,2 30icr ADDRESS /176 E geo4-beCITY alrey;,/ 24'S ZIP 9.9a/Ca BOX 4 SEWER AVAILABILITY WATER AVAILABILITY BOX 5 ESTIMATED PROJECT COST sormodo, "Tr EXISTING BLDG. VALUATION $ BOX 6 PROPERTY TAX ACCOUNT NUMBER y,-67,2, 7. 7/ 7 7 LEGAL DESCRIPTION (IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) CENSUS NUMBER LOT NUMBER BOX 7 BUILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR / 2ND FLOOR 3RD FLOOR / OTHER / BASEMENT FINISHED / BASEMENT UNFINISHED / DECK / GARAGE / CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING FT. BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION ( ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE ( ) COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT. ( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE— SQ. FT. BOX 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. BOX 10 Water Service meter size(if known) Also see BOX 4 BOX 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) BOX 12 Street use may require a" Street Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public Works Department. I 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 THE ABOVE PREMISES TO PERFFOOR_ T)IE WORK FOR WHICH THE APPLICATION IS MADE. OWNER/AGENT ��.►;� DATE / 7/3 (OVER) This document originally contained , confidential credit card information which was redacted pursuant to RCW 19.255.010 and the original document destroyed pursuant to SOS DAN GS2014-030. I hereby authorize the City of Spokane Valley to charge ttfee for this permit to my credit card: i r 0 Mastercard Ake __ --t."'— —_ ration Date ,_1 - , • ->1 Print the name of the Holder ]� _ - CC4,' 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 DEPARTMENT 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 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 '7) .-". —7/-3-- PLAN CHECK FEE 7-7i---D PLUMBING FEE MECH. FEE TOTAL FEES WSBCC SURCHARGE `G S O ENERGY SURCHARGE OTHER CHARGES ._/ AMOUNT DUE (,(�% f ir BUILDING DEPARTMENT APPROVALS Z _ ' .d BY DATE i ASSIGNED ADDRESS . Oie THESE PLANS MUST BE K ON THE JOB SITE A TO FIE THIS DI G-SU � T c CORRCTIpN S V AppA01,Fo k... ey oik E 664-64etir-- 20 c r ._ , j2o 342/