2003, 05-08 Permit App: BD03-369 Addition City of (oW 003 CP
SPOKANE VALLEY fo (p ' 0037
PERMIT # 60 03- 3Le 1
BUILDING PERMIT APPLICATION
Box 1 OWNER /%3GL IAI ✓✓ Rinvis Tn� JOB LOCATION I2>/1r c
OWNER'S ADDRESS CITY OII4 PHONE 7°7 33i J
DESCRIBE JOB i' ' ) t%/-4YI/L r 10
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME PHONE
CONTRACTOR'S ADDRESS CITY
•
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT /d7�Z �f,4 7 v PHONE 2Y i''f
ADDRESS /2 )/y (, 23 '�a? CITY C9l %-- ZIPY-2/ Co
BOX 4 SEWER AVAILABILITY <L- t, WATER AVAILABILITY
+649419-
BOX 5 ESTIMATED PROJECT COST$ .� EXISTING BLDG. VALUATION$ /6 d 9c)
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 inti ci / leitIC 2ND FLOOR
3RD FLOOR / OTHER / BASEMENT FINISHED 2O Y
BASEMENT UNFINISHED WO! DECK -23 I 19 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
ion oc
ASSIGNED ADDRESS
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APPROVED
THIS BUILDING,SUBJECT
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Square Feat 1,789
ToW Rooms 7
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"" 250
„ Be 1635sf P-Finish
Garage2 Car
�_ .;- _ £=>__ Fri 2 Fireplaces
REAR OF
SUBJECT PROPERTY
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Mac, apra€serrM Rea!Estate Appraisal Software by Bradford and Robber(800)622.8727.