2003, 05-02 Permit App: BD-03-225 GarageCity Of
SPOKANE VALLEY
PERMIT #�=�a�
BUILDING PERMIT APPLICATION
Box I OWNER , A�su� %��J,T/i/l�ufi/Li' Jos LOCATION it 3 E &71% '
OWNER'S ADDRESS /S(_o�f Fir! CITY , PHONE qp Z3
DESCRIBE JOB L7�l2GfG
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
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BOX CONTRACTOR'S NAME l LfvL- PHONE__Yc/�;5 B
CONTRACTOR'S ADDRESS_ 62r, F j46,?til) kc.l) CITY SArCI/�iiAh
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND CC
BOX 3 CONTACT PERSON OF PROJECT TO!/,i/ J_f,4 Fc tl� PHONE
ADDRESS I'Zf2 /r/�([./,u �� Zr) CITY 6A,1 jL ZIP
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BOX4 SEWER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST $ 00Y2 �w 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
FLOOR—/
-
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED _/ DECK / -GARAGE %- ,K
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING FT.
BOX 8 ( ) SINGLE FAMILY (X) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL / INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE _Sq. FT.
-----------------------------------_----_ _----_M -US SURFACE- -_------ --- --
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 1 O 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 pOR7WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT( / vA DATE 52 Z-42&63 (OVER)
I hereby authorize the City of Spokane Valley, to charge the fee for this permit to my credit card:
Visa Mastercard
---- ---- ---- ---- Expiration Dale
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 _. DISAPPROVAI
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 STnRIF.R
SQ. FT.
BUILDING SQ. FT.
SQ. FT.
BUILDING SQ. FT.
TOTAL SQ. FT
L
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 1 AMOUNT DUE
BUILDING DEPARTMENT
ASSIGNED ADDRESS
BY
DATE
}pj4vc ie 11707E. SPRAGUE, STE 106
`f SPOKANE VALLEY, WA 99206
(509)688-0036 FAx(509)688-0037
STTE INFORMATION
SiteAddress:qu,-s q"-�Aoe
9Iq 20(-e
Parcel Number: �AS,2()2, go5,9
Subdivision:
Block: Lot:
Zoning: nWater Dist:
Owner:
Address:
Building Inspector: Ke U i A AA
BUILDINGS:
PLANNING:
PROJECT TRANSMITTAL:
TRANSz urTAL DATE: 5--.) -c'3
PERMFT INFORMATION
Permit Number: � D03-225issue Date:
Permit Use:
Applicant: PI _
Contact: `� t 'j, "A
Contractor: zt�
Setbacks —
APPROVALS
Phone:
q7�93-50�
Phone: LOT
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Right: t. Rear:
APPROVALS
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