2003, 06-24 Permit App: BD03-697 Addition • 6,ST-063 ,6
city of �'g x ?E?'--- 3 7
SPOKANE VALLEY
PERMIT # 612- oV--6'9 7
__-- BUILDING PERMIT APPLICATION p fl
Box 1 OWNER ' 'C -Si-JGh. J JOB LOCATION '141 &-- `AL I JUN 2 4 2003
OWNER'S ADDRE'S , .i CITY, . s ' PHONE D r
/ii. -
DESCRIBE JOB 1 - U n
_t • /� � •moi• _ t_r '- Ig► ./ �. /'�Ci..� id� .� e� n 1\
Hew s -is-,iJEu>s pm -A., ez) !7i • ,v-//eevw -' hy ,C/ u.) silo
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED X
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME _ 1-311.- _ t aa v-a-> PHONE --W- -4p(o
CONTRACTOR'S ADDRESS 11�69 /I 6at--- P- CITY&1--ea -A-11--
CONTRACTOR'S REG.# .....ST-Lc-J4-rt 97,9?D, EXPIRATION DATE J-I9 C-5-
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT _ k - PHONE 29- ,- - 606'
ADDRESS Oar 6009 Al 1 Ra( CITY 5I ZIP Q9i2o
BOX 4 SEWER AVAILABILITY7 WATER p�
AVAILABILITY 7�T 45
VBOX 5 ESTIMATED PROJECT COST$4.45A29, ' EXISTING BLDG. VALUATION $ Ifri/� , 7. -
J.
*BOX 6 PROPERTY TAX ACCOUNT NUMBER 4/16% / /e071 _524-5 a�,
// LEGA DESC PTION J�
v/ffwer,/ . /7-f"2
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing/ ropose 1ST FLOOR / 2ND FLOOR /,27g2Fh`
3RD FLOOR / OTHER / BASEMEN, .FINISHED /
�n ,
BASEMENT UNFINISHED / ECK) l 1 GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING XV FT.
BOX 8 (C) SINGLE FAMILY
( ) MULTIFAMILY(NO. OF UNITS (/�) NEW CONSTRUCTION
( ) COMMERCIAL/INDUSTRIAL ) ( ) EXISTING STRUCTURE
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:RFOR THc •-K FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT A 'rot _ 1 G ".��/ DATE (pAVO-6 (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
DO NOT PLACE ANY BUILDING 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 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 RECD 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
Received
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