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2003, 04-07 Permit App: BD03-043 Addiiton r e City of SPOKANE VALLEY PERMIT # BUILDING PERMIT APPLICATION Box 1 OWNER \o‘c}ra .}L\ JOB LOCATION j? L ) OWNER'S ADDRESS CITY4f,4.4c PHONE j 4•�L 1�/ DESCRIBE JOB c)dr- C, THIS PROPERTY IS OWNED BY: SINGLE/MARRIED YV)Av" t PARTNERSHIP CORP. BOX 2 CONTRACTORS NAME (7-)t'o r I I>, PHONE ,`;1 ) CONTRACTOR'S ADDRESS Z`> , CITY Ek CONTRACTOR'S REG.# SPLI K. SP`V'10 rjol EXPIRATION DATE bA/C.) (CARD MUST BE PRESENTED AND COPIED OR VERIFIED) BOX 3 CONTACT PERSON OF PROJECT V)4,.41 �, LA PHONE (6-e) c L - 2-F/ ADDRESS '. '` ,9 ,.7 (; r-:°', CITY )c ZIP `/ ,2c2,a BOX 4 SEWER AVAILABILITY ye- - WATER AVAILABILITY BOX 5 ESTIMATED PROJECT COST$ /If `�'i7 " EXISTING BLDG. VALUATION $ x S,L2C"t' BOX 6 PROPERTY TAX ACCOUNT NUMBER LEGAL DESCRIPTION (IF NECESSARY, PLEASE SUBMIT A SEPARATE„ PAGE WITH THE LEGAL DESCRIPTION) J CENSUS NUMBER LOT NUMBER V/ BOX 7 BUILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR ” 414 / 2ND FLOOR 3RD FLOOR /_ OTHER / BASEMENT FINISHED / BASEMENT UNFINISHED / 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. 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 (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 BUILDING SQ. FT. @ _ BUILDING SQ. FT. @ _ BUILDING SQ. FT. @ _ BUILDING SQ. FT. @ _ TOTAL SQ. FT. TOTAL VALUATION BUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE OTHER CHARGES AMOUNT DUE BUILDING DEPARTMENT APPROVAL BY DATE ASSIGNED ADDRESS oier X11��� 11707 E. SPRAGUE, STE 106 Spa 400.00V Y"[ ey SPOKANE VALLEY, WA 99206 (509)688-0036 FAX(509)688-0037 PROJECT TRANSMIIIAL: TRANSMITTAL DATE: ` 7 SITE INFORMATION PERMIT INFORMATION Site Address: 17),2F ? Permit Number: X03- Issue Date: /7/03 Permit Use: Pc r to Co P.r Parcel Number: ,s7 c2q, ©b I Le Applicant: Be E i c k ,2mce AJS Subdivision: -C � 4'\ P c{e Pd Block: Lot: Phone: triC,_ (o J Zoning: 2 3.6 Water Dist: Contact: t Owner: -RO b P Ce (fDecs e S t?Y Phone: Address: cbr 1 g --iiN Contractor: ist spo \cell ccolLe Building Inspector: . Setbacks-Front:N/ Left: Right: 3J Rear:2 (.„ APPROVALS BUILDINGS: ) e�. _ ) CPLANNING: H v ',NGINEERS: HEALTH: SEWER: FIRE DISC APPROVALS WATER DIST: �. STORMWATER: OTHER: „i. e... , ... 8.0 00 ' ,... I . .....„‘Cbd. le /0. *IDE 3 1\ 7' Unts• ESM t . . .. . . . . . . . . .. . . . . . . . . . . . . \. . .... . . . . . . . . . . . . . . . . . . . . . . 301 e• • • • 1 46 1 22 les 7 26 . . .k... ‘ ,... 2.5 i a Lki IR. Cr/ . 4) kt loots ‘so 101. Oa 1 •yit 7 .5 vial v 7 6 (52, .‘ • . rikA • • • \ 12, 422 Sr *** 3,250 S. r. Ittj 0 . (72 • . . .,_ 4, • \rt.. . 1 • - . \ti& $ 0 • ' i g 1 ,,- 22 . $ 4 ilk• 5”- - 4tkp N '7 7, ,40T r APP •OVED ,� f THESE PLANS MUST BE KEPT ; /151) .,21(2 J-, ,e. ON THE JOB SITE , / f . tr-' - ) ___,_ > k 4 ,.)° Nile% N ' W w \t,IA ki Q) '-----------------] i-- -V-V:-22 ave_T-..,, _ 1 , - s [ !$� ; iS."' Jf// jk f( t o 4 a w ;i , fW w '..�_.. _ �,._..�.'` m \z 8 " v ` , ,, ,,,,. . „ .,..., '.. ./ -4 -...., -.-- ,,, ... . ,/, co u., \ ,, ,. , z . �\ yx , ... ., . /..,, \r\ 1111 T 7 I r S 0 a .N, r 4 k Cr, N DI \ ,i * i4, f' W lig n n ►( `` 1r ''' - 0 :elk . 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