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2003, 04-07 Permit App: BD-03-037 DeckJl,4� 11707 E. SPRAGUE, STE 106 so, Valle'y SPOKANE VALLEY, WA 99206 (509)688-0036 FAX (509)688-8,37 SITE INFORMATION PROJECT TRANSMITTAL: TRANSMITTAL DATE: PERMIT INFORMATION Site Address::O l 23. s» ek Parcel Number: 46-gt/Q•adOt c Subdivision: tt g,l1-1 �o( Block: Zoning: tke_3•3— Lot: LJ. Water Dist: Contact: amie - Permit Number: g©03 -03-7 Issue Date: 'I/7l03 Permit Use: Dec � 2 X Applicant: time) ce_C Owner: j4ciCCA rbi 3 h kakike E_ Address: Building Inspector: Kyo, ikk Contractor: Phone:21d -6-7 /3 Phone: Setbacks - Fronhp) k Leftj k Right:. pRear: APPROVALS ENGINEERS: HEALTH: SEWER. FIRE DISI WATER DIST: APPROVALS STORMWATER: OTHER: City of SPOKANE VALLEY a PERMIT # BUILDING PERMIT APPLICATION Box 1 OWNER rtti Met JO: LOCATION /MCR Cfr (Scarf - OWNER'S ADDRESS I.r. 4' /k. PHONE _ 57 / 3 DESCRIBE JOB here- /r -)C THIS PROPERTY IS OWNED BY: SINGLE ARRIED PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME ()pi her PHONE CONTRACTOR'S ADDRESS CITY CONTRACTOR'S REG.# EXPIRATION DATE (CARD MUST BE PRESENTED AND COPIED OR VERIFIED) BOX 3 CONTACT PERSON OF PROJECT 0 (2 r ADDRESS CITY PHONE ZIP BOX4 SEWER AVAILABILITY 3 WATER AVAILABILITY '%'C_S BOX 5 ESTIMATED PROJECT COST $ /c) -O d EXISTING BLDG VALUATION $ BOX 6 PROPERTY TAX ACCOUNT NUMBER LEGAL DESCRIPTION (IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) CENSUS NUMBER LOT NUMBER BOX 7 BUILDING SQUARE FOOTAGE (Existin 3RD FLOOR / OTHER / BASEMENT UNFINISHED / DECK 1ST FLOOR / 2ND FLOOR / BASEMENT FINISHED l /9 _ GARAGE CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING FT. BOX 8 ( ) SINGLE FAMILY ( ) MULTIFAMILY (NO. OF UNITS ( ) COMMERCIAL / INDUSTRIAL ( ) TENANT IMPROVEMENT ) NEW CONSTRUCTION ( ) EXISTING STRUCTURE TOTAL AREA OF PROPERTY SQ. FT. 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 Y KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES 'ERFRM ., I • r . r WHICH THE APPLICATION I M DE.. OWNER/AGENT i % DATE `f%/t3 (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 REMARKS DISAPPROVAL DATE 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 PLAN CHECK FEE PLUMBING FEE MECH. FEE TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE OTHER CHARGES AMOUNT DUE BUILDING DEPARTMENT APPROVAL BY DATE ASSIGNED ADDRESS • Co S matfit, efrr 71?