2003, 06-24 Permit App: BD-03-690 Reroof LJ
City of JUN 2 4 2003 Phone 688-0036
SPOKANE VALLEY D �. FAX 688-0037
1) a ii r ft 0 kr :S Inspection 688-0054
PERMIT # Q3 '67v
�//BUILDING PERMIT APPLICATION
Box 1 OWNER Caren/ N7.1y- JOB LOCATION 4.30`11 E8tk--
OWNER'S ADDRESS d CITY ST. PHONE
DESCRIBE JOB ygcr ofS ge ttli+b
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED A PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME A Fri 4044 LIC Nt.J Qct JCP" PHONE Stttt
CONTRACTOR'S ADDRESS 1201 N• N.+nwlr•a,.l tr CITY 1484-€47LaK.. ttA—
CONTRACTOR'S REG.# A FFotp4 fo ObN EXPIRATION DATE O`i " 'Z eey
(CARD MUST BELZ PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT SJfii.J jtnrd PHONE 3 77e •]Y,(
ADDRESS CITY ZIP
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST$ Zgo" 0 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) 1ST FLOOR I 2ND FLOOR
3RD FLOOR / OTHER / BASEMENT FINISHED I
BASEMENT UNFINISHED / DECK I GARAGE /
CARPORT / TOTAL I HEIGHT TO PEAK OF BUILDING FT.
BOX 8 (V) 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 PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT _DATE 4-2 N-J (OVER)
s-vappbp 4-16-03
at
thereby 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
TU BUILDING SQ. FT. @ "gam _ e3 aj'
�! BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING PERMIT NO. PLAN CHECK FEE RECD RECEIPT NUMBER
PERMIT FEE 37'r / bf
PLAN CHECK FEE 6� PLUMBING FEE MECH. FEE
�f0 ^/
TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE I �7IL!.�7/p�
OTHER CHARGES AMOUNT DUE 0 7
BUILDING DEPARTMENT APPROVAL BY /
DATE - 2 /-0
ASSIGNED ADDRESS
Received