2003, 04-19 Permiit App: BD03-456 Reroof City of (,��- 003(p
SPOKANE VALLEY Ft2X (0 i- 0037
PERMIT #
BUILDING PERMIT APPLICATION
Box.1 OWNER C
VA
a 1 JOB LOCATION 1 Z?j
OWNER'Sf• l
ADDRESS CITY PHONE
DESCRIBE JOB fZCO-c-1 K •
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP. �C `
BOX 2 CONTRACTOR'S NAME � (C e Cv r11 PHONE tat/-
CONTRACTOR'S ADDRESS PLS D( CITY 5e0Yk. q
CONTRACTOR'S REG.# /'A' ((x ,Of) 0q 3 0
EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OrR VEFVF(ED)
BOX 3 CONTACT PERSON OF PROJECT
/39/Ke MG / PHONE e9•9 - 0_56 S'_
ADDRESS CITY ZIP •
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
- F
BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG.VALUATION$
E30X 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
- h
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
' I
• CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING FT.
30X 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY(NO. OF UNITS ( ) NEW CONSTRUCTION
( ) COMMERCIAL/INDUSTRIAL ) ( ) EXISTING STRUCTURE
( ) TENANT IMPROVEMENT TOTAL AREA OF PROPERTY �I SQ. FT.
IMPERVIOUS SURFACE_ SQ. FT. •
3OX 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. '
OX 10 Water Service meter size(if known) Also see BOX 4
OX 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)
DX 12 Street use may require a" Street Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
iERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
JRRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
LOVE PREMISES TO PERFORM THE WOR 'SR HICH THE APPLICATION IS MADE.
NNER/AGENT DATE 0 3jI /i ( (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
I BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
= BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING PERMIT Np. PLAN CHECK FEE REC'D RECEIPT NUMBER
't
PERMIT
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES , WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES ;I AMOUNT DUE
BUILDING DEPARTMgNT APPROVAL BY
DATE •
ASSIGNED ADDRESS
•