2003, 06-17 Permit App: BD03-625 CarportCity Of
SPOKANE VALLEY
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 O 1 JOB LOCATION � � 4Q /
OfCe7RlJOB
ESpc7F'�%�Qrj.1N6- 7
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME PHONE
CONTRACTOR'S ADDRESS CITY
CONTRACTOR'S REGM EXPIRATION DATE
CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX CONTACT PERSON OF PROJECT PHONE-'ZL-
BOX4 SEWER AVAILABILITY WATER AVAILABILITY i
BOX 5 ESTIMATED PROJECT COST $ EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER==�1'Ltf = =_= I---- --------------------
LEGAL DESCRIPTION. 3
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
ec_ ____ __ ---_____—__________ o 'fes
BOX 7 BUILD G SQUARE FOOTAG fisting /proposed) 1ST FLOOR I 2N RLQDR
3RD FLOOR /— OTHER / BASEMENT FINISHED /
BASEMEN
GARAGE /
CARPORTT� E� r TAL DECK HEIGHT TO PEAK OF BUILDING F
80X8 ( )SINGLE FAMILY ( ) NEW CONSTRUCTION N(. -!}.E''
MULTIFAMILY (NO. OF UNITS �) ($Q EXISTING STRUCTU
COMMERCIAL / INDUSTRIAL OT L AREA OF PROPERTY Z,9 G 5 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 A Y K Q LEDGE AND FU ER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TOP 42F E WO E FOR W HE APPLICATION ISM E.
OWNER/AGENT DATE / 0 (OVER)
I hereby authorize the Clty 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 ANYBUILDING 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
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
TENANTIMP.
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
RECD RECEIPT NUMBER
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE MECH. FEE
TOTALFEES
WSBCC SURCHARGE
ENERGY SURCHARGE
--OTHER CHARGES..—
_._. - —".—
___... _ AMOUNT DUE
BUILDING DEPARTMENT
APPROVAL
BY
ASSIGNED ADDRESS
Received
DATE
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