2003, 09-10 Permit App: BLD-03-02446 ShopSEP -10-2003 WEU 1128 RM RVISTR TKRNSM UNS
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PERMIT APPLICATION r
ox -I ONWV Rt.�'_RAIG.-N GA2T JOTSLOCA'TION 11322 9,21-11fOWNERS ADDRESS - Cvey .SF0MNpHON[ ___a31- CCC2 A W / 49 S -ZZ4Wwk
DESCKIB[_ JOB ��C ,$ 40p IN _$O U_TW fr eo"ji;p or LaT '
THIS PROPL'Rl Y IS OWNEDY SINGI_ ARRIED _Clef g1Ct_ N. Ir iG� str
PARTNFRSHIP �- C RP.�
)X 2 CONTRACTOR'S NAME — _,PHONE
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CONTRACTOR'S ADDRESS CITY
CONI CON R/1CTOR'S REG.# EXPIRATION DATE _
(CARD MUST BE PRESENTED AND COPIED ORVE IFIED)
-------------------------__-_------------
)X3 CONT•ACI•PERSON OFPRO.1CT iCRrrjG N• ! isly"-PHON[�E���-
ADDRESS__-�`? T .'�
CIN 10
L /1 ZIP �•TL C
.--•---•---=- — -----------------------
)X4 SEWERAVAILAR{LI1Y- - WA7ERAVAILABILITY /V�_
1X5 ESTIMATED PROJECT COST 2Ot)c) EXISTING BLDG. VALUATION $
----- - ----
,X 6 PROPERIY TAX ACCOUNT N M13ER- 45 i 83 -7-5.? 1`_—
LEGAL DESCRIPTION
(AZ l Fr—
(1F NECESSARY, PLEASE SUIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) y�
CENSUS NUMUI-11,^-_-•_-L�' NUMBER
C 7 BUILDING SQUARE I-OOTAGE �Exlstinal proposed) 1STFLOOR U / �t 2ND FLOOR13RD FLOORT OTHER /` BASEMENT FINISHED /
BASEMENT UNFINISHED -��i_ DECK _ / _GARAGE
CARPORT _`•!_ _IOIAL_ / HEIGHT TO PEAK OFBUfLDING 15SFT.
8 ( ) SINGLE FAMILY - - (�() NEW CONSTRUCTION --
( ) MU1.711FAMILY (NO. OF LINTS EXISTING STRUCTURE
( ) COMMERCIAL / 1NDUSTRI' L TOTAL AREA OF PROPERTY___L2t`-1' D SQ. FT.
( ) I ENANT IMPROVEMENT• IMPERVIOUS SURFACE _ - SQ. FT.
9 PLUMBING FIXTURES (Including rough -ins) MECHANICAL APPLIANCES
-
PLEASE USE THE: ATTACI IED P UMBING I MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SYSTEMS, HEATING AND AIR U ITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS,
(_AWN SPRINKI .ER SYSTEMS, B CK FLOW PREVENTERS, ET AL. - 1_-----,
D Watcr Service meter si/e f known) Also see BOX 4
1 Septic Tank -• Not generall allowed in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor and t ie Health District (See BOX 4)
Z Street use may require iitreet Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
•Y UNDERTHH, KNALTY OF PE .JURY THAT THF INFORMATION FURNISHED BY ME IS TRUE AND'
:CT TO THC: BEST OF MY KNOWL -DGE AND FURf HER THAT I AM AUTHORIZED BYTHE OWNER OF THE
'PREMISESTOPERFORMTHEWORKFORWHICHTHFAPPI1rnT1('N" ^� PAGE. 01
SEP 07 2003 12 33
btr-IU-000J R.I.) 11;Ct7 ICnv15In imtir ru urJ rnr nu. ouy 4�0 oo4c r. uiiui
1 hereby autiiorizc the City ofSpoksnc Valley to chtxg-e the fee for -
vija �Per,nit to my credit'e-aa- -- -----
Mastercard c(
1'xLit the mute of the Ifoldcr
a _� C ~'1 Sly--
el
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3 0` cI �+ ___ -___ -_...„=„====.==.,.......„.........-OFFICE USE ONLY-PLEAS - -_--=_-___ _�___:__=_�_; ;_-- __
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E DO NOT WRITE BELOW THIS LINE_
>. c n ZONE ETBIACKS:'FRONT' - ____ =—_- --- _--•= _ ___
S ' SIDE
-o e o: E ti �_. :i -�--�_REAR -y - _ -.
m - « 3 N PLANNING DEPARTMENT APPROVAL
LIMIT"
oat
E 13 W
ROVAI��__ DISAPPROVAL ~~-
" z REMARKS ^DATE
N
� 01 a.m� - --
0 10 u ° _ -
vv r' SEPA: EXEMPT �-`�'�-__--_--
-_-_ --.�_NOT EXEMPT ---'
.o a FIRE DEPARTMENI{,�PPROVAL_- -1 T==�- __-"__'__
��DISAPPROVAL
REMARKS� �� ----- DATE
PUBLIC WORKS DEY�TMENTAppRUVAL -____^___-__�__~_- _^-.---`_..___,=-�=T=
TYPE OF JOB: '' .:_l______,,,...=.:__ _=======- • -- -
N�RESIDENCE RES.ADD/ALT y � ^- - '
NEW COMMERCIAL ' NEW INDUSTRIAL_._._BIND. _ _
COMM.ALT/ADD -_NEW MULTIFAMILY - -
MULTIFAMILY ADD/ALT •---- N0.UNIT'S
TENANT IMP._ -ROOF -- • _._
OCCUPANCY --�OTt iER ---
-,-----hTYPE OF CONSTRUCTION _ ~
_STORIES
BUILDING SQ.FT. • ---
—�-.—___BUILDING SQ, - -_.
BUILDI -�—
=:=--T--....l..__.1.__-
TOTAL VALUATION.
TOTAL SQ.FT.
'BUILDING PERMIT NP._- PLANCHECK FEE �"--------_
. RECD
j -^RECEIPT NUMBER
PERMIT FEE _PLAN CHECK FEE •4~ --�-•--_
_ PLUMBING FEE
TOTAL . MECH.FEE`__
FEES
---_1 WSDCCSURCHARGE
.._ENERGY SURCHARGE
OTHER CI LARGES ) - -
—�-�- AMOUNT DUE _ _
BUILDING DEPARTMI$NT APPROVAL
__BY
DATE
ASSIGNED ADDRESS •
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SEP 07 2003 12 34 PAGE.01
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Puget Sound Office - RO. 1.tox 6755 • Lynnwood, WA 98036 - (425) 672-9651 - FAX (425) 744-1253 - nso 9 dhiltlC.com
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Tri•C• iiies 01'rice - 81; Columbia Park Tmil - Richland, WA 99353 • (509) 627-4719 • FAX (509) 627-7395 - dlrnQ(lhiule.,com
fu,,ci Sound Office - RO. Box 6755 - Lynnwood, WA 98036 - (425) 072-9651 - FAX (425) 744-1253 - psoCwdhiu.Ic.cum
PAGE.03
SEP 07 2003 12:35