2003, 03-28 Permit App: 91003554 Sewer e
MAR 28 2003 14:89 FR f TO 5320893 P.02/82
BOX 10 WATHR SERVICEMETER SIZE(IF KNOWN) (ALSO SEE BOX 4)
BOX1I SEPTIC TANK—NOT GENERALLY ALLOWED IN THE CITY OF SPOKANE VALLEY. FOR
SPECIAL CIRCUMSTANCES CONTACT THE SEWER PROVEYOR AND TEE HEALTH
DISTRICT. (SEE BOX 4)
BOX 12 STREET USX MAY REQUIRE A'STREET USE PERMI'P FOR SEWER,WATER,SIDEWALKS,
SIDEWALKS,CURB CUTS.CONTACT TBS PCBLIC WORKS DEPARTMLIT.
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(AM AUTHORJZED BY THE OWNER OF THE
ABOVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/.AGENT DATE
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
PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE
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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.
SO.FT.
SQ.FT ® _
SQ.FT.
TOTAL SQ.FT. TOTAL VALUATION 5Z 5 -
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
ASSIGNED ADDRESS
RECEIVED ACCEPTED FOR FILING
*.. TOTAL PAGE,02 v*
PAGE.83
OCT 19 2003 08:48