2003, 07-07 Permit App: BD-03744 Addition) ne 11707 E. SPRAGUE, STE 106
00Valley SPOKANE VALLEY, WA 99206
(509)688-0036 FAX (509)688-0037
PROJECT TRANSMITTAL:
TRANSMITTAL DA 1'E:
SITE INFORMATION • PERMIT INFORMATION
Site Address:
J. 3 Z !'' . E 7111.
Parcel Number: 1-45-aqa21. 110
Subdivision:
Block: Lot:
Zoning: Water Dist:
Owner:
Address:
Building Inspector:
Permit Number: $ O! 3 -7 Witssue Date:
Permit Use: s A_,&Q 64 /c(
Applicant:
Contact:
Contractor:
Phone:
Phone:
Setbacks — Front: Left: Right: ' Rear:
BUILDINGS: P
APPROVALS
- 7-3
PLANNING:
ENGINEE
HEAL
SE ' R.
DIST=
f WATER DIST: -'
APPROVALS
STORMWATER:
O 1'HER:
City of SPOKANE VALLEY
Building, Fire and Public Works Fees Receipt
Applicant/Business Permit No. e)Dt 3 -7 of
Project Name Date
Site Address \32l`' E- '7t -N
Please Receipt the Following:
------------------------------
Check Number Receipt Number
Payers Name
Address City
BUILDING DEPARTMENT
001.059.322.10.01
001.059.322.10.02
001.059.322.10.03
001.059.322.10.04
001.059.322.10.06
001.059.322.90.01
001.059.345.83.01
001.059.345.83.03
001.059.342.40.02
001.059.237.10.98
001.059.237.10.02
FIRE DEPARTMENT #
001.059.322.10.07
001.059.322.10.08
001.059.322.10.09
001.059.322.10.10
001.059.322.10.11
001.059.322.10.12
001.059.322.10.13
001.059.321.30.00
001.059.342.40.01
001.059.237.10.99
OTHER:
Building Permit $
Plumbing Permit $
Grading Permit $
Mechanical Permit $
Demolition Permit $
Misc. Permits and Fees $
Plans Check Fee $
Energy plans check fee $
Zip
1'S2. S
SPECIAL Inspections $
Bonds / Deposits $
WSBCC Surcharge * $ 4. 5c.";P
Plans check fee
Sprinkler plans check
F. A. Pians Check
Misc. plans check
Fire Alarm inspections
Sprinkler inspections
Misc. Inspections
Fireworks Permit
UFC permit fees
Bonds / Deposit **
PUBLIC WORKS
001.059.322.40.00 Right of Way
001.059.342.40.03 Special Inspections
001.059.237.10.99 Bonds/Deposits (cash)**
TOTAL AMOUNT DUE
$
$ tO7.2,0
* To be sent to Wash. State Building Code Council quarterly.
# 65% of figure to be sent to the Fire Department Quarterly, except bonds etc.
* * Liability Insurance verification may also be required.
ewf
City of
SPOKANE VALLEY
PERMIT #
BUILDING PERMIT APPLICATION
F/4x en -d°3%
Box 1 OWNERJ /, L flfl g2., f JOB LOCATION /'Z / ,E '
OWNER'S ADDRESS/10 /R£ 744-, ITYc#dcp.e, PHONE1255Ann.9 '
O
DESCRIBE JOB YO -e..1-1 e -e -c .+� -F- A4a.1c�.,ncQ rated
THIS PROPERTY IS OWNED BY: SINGLE/ MARRIED)
PARTNERSHIP CORP.
BOX2 CONTRACTOR'S NAME vLe/4 PHONE nB-SS.2%
CONTRACTOR'S ADDRESS / 3 a. 1 S F V L CITY crp -2 l.�/�
CONTRACTOR'S REG.#
EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT //`�..-, %7t15r# PHONE 92$- SS -29
ADDRESS 72211.24 st. 9 �h CITY Cl1>�(CZIP %gyri / ro
BOX 4 7SEW ER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST $ 2.S-/ ('D EXISTING BLDG. VALUATION $ /0 S,c oo
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 /
BASEMENT UNFINISHED
OTHER
CARPORT / TOTAL
DECK
1ST FLOOR /22S/ 2ND FLOOR
BASEMENT FINISHED
GARAGE
HEIGHT TO PEAK OF BUILDING
FT.
BOX 8 (...\-)'SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANTIMPROVEMENT
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY / 2 4120 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,
PR1NKLtF bYSTEMS;EACKILOW-PREVENTERSET At. - -
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 PERFORM THE WORK R WHICH THE APPLICATION IS MADE.
OWNER/AGENT DATE c21 3 (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
DO NOT PLACE ANY BUILDING UNDER POWER LINES OR OVER INCOMING GAS LINES.
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. I ma @ (923D = y6 3430. oO
111.(0
BUILDING SQ. FT. (p2,5 @ l -1 . (0 = 111 c 75 .
1
BUILDING SQ. FT. @ =
BUILDING SQ. FT. @ =
TOTAL SQ. FT. TOTAL VALUATION 'Y 2 2SS.P)O
BUILDING PERMIT NO. PLAN CHECK FEE REC'D
RECEIPT NUMBER
PERMIT FEE (o (0I -17S PLAN CHECK FEE in_/s' PLUMBING FEE MECH. FEE
TOTAL FEES WSBCC SURCHARGE 4.5-0 ENERGY SURCHARGE
OTHER CHARGES AMOUNT DUE S-60.?, "7
BUILDING DEPARTMENT APPROVAL BY
ASSIGNED ADDRESS
Received
DATE