2003, 04-16 Permit: 03-104 Roof N
City of
SPOKANE VALLEY
PERMIT# C73— ( .
BUILDING PERMIT APPLICIION
Box 1 OWNER ‘"1-evk 0i,Ue,t JOB LOCATXO (2
OWNER'S ADDRESS ` 3 �Y` r, . a, ITY (/.:a ( PHONEI
1Sr �
1 5G -gr73
( Sc.,,c n
DESCRIBE JOB 1�,7Q T /-e, - ,,-cc--- /1�-e -r c c i
THIS PROPERTY IS OWNED BY:SINGLE/MARRIED PARTNERSHIP
CORP.
BOX 2 CONTRACTOR'S NAME S/'4,c. (5 i--(01.--v. P-,4d. PHONE____:y1. -S
CONTRACTORS ADDRESS L- .� /4i'. I/0 i-, CITY ��, (-C- a7,�
CONTRACTORS REG.# EXPIRATION DATE • i G LIS
(CARD MUST BE PRESENTED AND COPIED)• '-' 5 0
BOX 3 CONTACT PERSON OF PROJECT PHONE
ADDRESS - CITY ZIP I
_I ,?..0
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
ob,BOX 5 ESTIMATED PROJECT COST$435.70. EXISTING BLDG.VALUATION S `
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION C ,7
Aa
(IF NECESSARY,PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) I 1(10
CENSUS NUMBER LOT NUMBER ► ,
BOX 7 BUILDING SQUARE FOOTAGE(Existing I proposed) 1ST FLOOR /- 2ND 4 ,
FLOOR / Z)\
3RD FLOOR / BASEMENT / DECK /
•
GARAGE / CARPORT / TOTAL I
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.
BOX 9 PLUMBING FIXTURES(Including rough-ins) MECHANICAL APPLIANCES
NO. WATER CLOSETS-URINAL GAS PIPING: OUTLETS
-BATHTUBS-FAUCETS NO. FURNACE,ELECTRIC GAS
PRIVATE SEWER SYSTEM (BTU RATING ) •
SHOWERS GAS HOT WATER HEATER
LAVATORIES CONVERSION BURNER
SINKS • BOILER:SIZE _
-DISHWASHERS AIR HANDLING UNITS
ELECTRIC HOT WATER HEATER HEAT PUMPS:SIZE
LAUNDRY WASHER OUTLET UNIT HEATERS
LAWN SPRINKLER SYSTEM AIR COOLING UNITS;SIZE
DRINKING FOUNTAINS COMMERCIAL HOOD
SUMPS,SPRINKLER VACUUM BREAKERS GAS APPLIANCES
. FLOOR DRAINS FIREPLACE INSERTS
BACKFLOW PREVENTER EXHAUST VENT FANS
VACUUM TYPE BREAKER APPLIANCE VENT REPAIR
HOT TUBS WOOD STOVE SYSTEM
TOTAL FIXTURES TOTAL UNITS
OVER
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PAGE.01
APR 13 2003 07!25
•
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BOX 10 WATER SERVICEMETER SIZE(IF KNOWN) (ALSO SEE BOX 4)
BOXI I SEPTIC TANK—NOT GENERALLY ALLOWED IN THE CITY OF SPOKANE VALLEY. FOIL
SPECIAL CIRCUMSTANCES CONTACT THE SEWER PROVEYOR AND THE HEALTH '
DISTRICT. (SEE BOX 4)
BOX 12 STREET USE MAY REQUIRE A"STREET USE PERMIT"FOR SEWER,WATER,SIDEWALKS,
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 WOR OR WHICH THE APPLICATION IS MADE.
w
OWNER/AGENT � DATE j6--03
OFFICE USE Y-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
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. RCTOF OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORIES
BUILDING SQ. FT. @ _ •
SQ.FT. @ _
SQ.FT. @ _
SQ.FT. @ _
TOTAL SQ.FT. TOTAL VALUATION
-7--
BUILDING PERMIT NO._ PLAN CHECK FEE RECD RECEIPT NUMBER ,rte
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH.FEE
TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE f
OTHER CHARGES AMOUNT DUE /
BUILDING DEPARTMENT APPROVAL BY
11
ASSIGNED ADDRESS 1./
VISA 4856 2002 0616 1864 EXP.01/05
SPECIALTY FIOME PRODUCTS,INC
ktCk SiMMET
RECEIVED ACCEPTED FOR FILING
•
APR 13 2003 07:25 PAGE.02
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