2003, 05-01 Permit App: BD-03-220 MH,p&anNowt
c 11707 E. SPRAGUE, STE 106.0004
y SPOKANE VALLEY, WA 99206
(509)688-0036 FAX (509)688-0037
S1Th INFORMATION
PROJECT TRANSMITTAL:
TRANSMITTAL DATE: 5--/.-0--s
PERMIT INFORMATION
Site Address: 30- E -<-
Parcel Number: 55) 9 .2. /&07
Subdivision: a pelt Va. (Ley Es+ #2.
Block: Lot: 7
Zoning: Re. 7 Water Dist:
Marl MaSsin
2•n309 6—‘11
Owner:
Address:
Building Inspector: ,e Ut h
BUILDINGS:
Permit Number: B003-2:20 Issue Date: s/r/03
Permit Use: p(ctGe -1 of sI /e14..)
2 bed'vonn
Applicant: Dwn tr
. Phone:
Contact: Mar kt- ac ,s/n3al -e
Phone: 9x %CJ
Contractor:
Setbacks -Fronts - Left:gsRight:lp Rear: 3S
APPROVALS
14 k n
PLANNING: 0 X tyrely l pit„
. ?moi /d5
ENGINEERS:
HEALTH:
/a
yOfe
au
SEWER -
FIRE DI$T=
APPROVALS
d egress.
UNTY ROADS. Work on street right-of-way may not be performed until staked by County Road Department and -work must be
rformed ig accordance with stakes. Points of ingress and egress must be approved by the County Engineer.
1VIf1G OF BUILDINGS. A permit is required to move an eaisting►huilding. When a building is moved on a County or State
ghway, clearance must be obtained from the County Engineer and/or State Highway Department.
'CESSORY BUILDINGS. Accessory buildings (garages, sheds, etc.) require a separate permit.
STRICTIVE COVENANTS. Builders should check provisions of covenants or dedications and easements running
rich are enforceable through civil action. County Officials can not bring action to enforce covenants or
APPLICANT FILL IN BELOW THIS LINE
Address _ Phone l 7 6:''
Address Phone
Address Phone ,
Address x l •e4Q 2'14)/t Phone C ��'`/i `TO
with the land
dedications.
ame of Owner
rchitect
iginee
ontractor
1 11
egal Des r ption of Property (Give complete description from deed, tax receipt, e )
c. — / � t_Pe_ 1'2 # f (2,2 ti
PeeALJ) A4. /9,51;-2 — 160'7
)ESCRIPTION OF WORK: New A Addition Remodel Moving Bldg. Zone / Fire Zone ,p
'7/' �/ / 5 ' Sewage System S �te % s oust. FJ•c.` `. ' .:-:::.-Ra
^ r `
;ize of Lotf� (Fr., Conc., Br., etc.) sd'
Total Sq. Ft 5' valuation % �j 6���
;tories _I—Dimensions %� X '
.1-...t.,5411../A4-.211 —
ioorns Baths Basement a " Foundation Const
Chimney _del:--- Fireplace(Number
�/%�� (Full, part, none) }
seat. System (-3,.. may+ Type of Roofing YY1.('tr17,) Ext. Finish �3'}"/.+'41," Int. Wall Finish
_ ,%-Ed id/,41_1 1 No. of Units _ Bedrooms /
Jse of Bldg. rY��%--t��" !�`�'�'�-� �{`/�
PLOT PLAN
property lines; (2) street or road locations; (3) location of existing and
lines aid streets; (5) dimensions of buildings; (6) location of sewage sys-
Draw sketch with dimensions showing: (1)
proposed buildings; (4) distance to property
tem and water supply lines.
NORTH
as show
SOUTH
RESIDENTIAL — COMMERCIAL
arehy certify information submitted 's
Owner or Agent Data /
A LAND USE OR STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOT A PERMIT.
DO NOT WRITE BELOW THIS LINE
/i
State License No.
Ind. Ins. Acct. No.
APPROVED B
Plumbing Permit
Heating Permit
Sewage Permit
Plans Received
Plans Checked
P1
<1411.
correct and there are no other structures located on this property except
Your street address will be
Sewage Permit Number
Remarks
Issued
1
Building
Permit
The zone is / l
2c1v Receipt
Issued
0u.. r...4..
City of
SPOKANE VALLEY
fleAA& cufrxR)14
14)0L -0) --
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 OWNER 7/247,/,4,-XM/44,JOB LOCATION i��� ;��z
OWNER'S AE5DRESSI� CITY PHONE gg8 787,
DESCRIBE JOB 9'9O1>°
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S ADDRESS
CONTRACTOR'S REG.#
PHONE
CITY
EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT PHONE
ADDRESS CITY ZIP
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)
CENSUS NUMBER
LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR / OTHER
BASEMENT UNFINISHED /
CARPORT / TOTAL
1ST FLOOR / 2ND FLOOR /
/ BASEMENT FINISHED
DECK / GARAGE
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 s
BOX 11 Septic Tank — Not generally allowed in the City of Sp
Your sewer purveyor and the Health District (See
BOX 12 Street use may require a " Street Use Permit" for s:wer, water, sidewalks, curb cuts. on the Public
Works Department.
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMA
CORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM A . -
ABOVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
ane V Ile . For special circumstanc contact
X 4)x .+..
FURNISHED BY ME IS TRUE AND
OWNER / AGENT
DATE
(OVER)
v.
D '
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 DEPARTMENT
REMARKS
PPROVAL DISAPPROVAL DATE
PUBLIC WORKS DEIARTMENT APPROVAL DISAPPROVAL DATE
41-
TYPE
L
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL _ COMM. ALT/ADD NEW MULTIFAMILY NO. UNITS
4 N
MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER
OCCUPANCY < TYPE OF CONSTRUCTION STORIES
.1 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
.I
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES a AMOUNT DUE
BUILDING DEPARTMENT APPROVAL
BY
DATE
ASSIGNED ADDRESS