2003, 04-23 Permit App: BD-03-148 Egress Windowy
City Of
SPOKANE VALLEY
PERMIT # f)D 07� (-i�
BUILDING PERMIT APPLICATION
Box 1 OWNER baa ✓`�c
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JOB LOCATION 65/D
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OWNER'SADDRESS
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CITYb J U¢FLPHONE `7Zy—
5,13,
DESCRIBE JOB
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP. '
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BOX2 CONTRACTOR'S NAME CIZ+FTs..+ Co tisMu.c$oa�WC PHONE634-22&-7
CONTRACTOR'S ADDRESS I z 3 () 5 'Fo 0�_; CITY b eo K''4r' E
CONTRACTOR'S REG.# 30/&7j-_? EXPIRATION DATE nfz o%C/
(CARD MUST BE PRESENTED AND COPIED OR VE IFIED)
BOX 3 CONTACT PERSON OF PROJECT PHONE 5 3e,'-
ADDRESS
4 ADDRESS I Z 3 r - L CITY S4wC ZIP �TLOZ
BOX4 SEWER AVAILABILITY WATER AVAILABILITY ,�7�
BOX 5 ESTIMATED PROJECT COST $ /RDD EXISTING BLDG VALUATION $ 77MU✓ Z
_________
BOX6 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 / 2ND FLOOR I_
3RD FLOOR /_ OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED I 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.
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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.
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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 310 z (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 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
ASSIGNED ADDRESS
/ qC),
DATE
f
BUILDING SQ.
FT.
@ —
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
PLAN CHECK FEE
PLUMBING FEE MECH. FEE
TOTALFEES_
WSBCC SURCHARGE
ENERGY SURCHARGE
OTHER CHARGES
AMOUNTDUE
BUILDING DEPARTMENT APPROVAL
BY
ASSIGNED ADDRESS
/ qC),
DATE
f