2003, 06-30 Permit App BD-03-717 Re-Roof;ity of Spokane Valley
1707 East Sprague Avenue, Suite 106
Jokane Valley, WA 99206
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 OWNER !
OWNERS ADDRESS
� �, - CITY
DESCRIBE JOB,
PHONE (509)688-0036
FAX # (509)688-0037
JOB LOCATION � f //f,:g dcr2J 7 f
PHONE
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED ,'J
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S ADDRESS
CONTRACTORS REG.#
PHONE
CITY
EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT
ADDRESS
PHONE
CITY ZIP
BOX 5 ESTIMATED PROJECT COST $ , _ _ EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR / OTHER
BASEMENT UNFINISHED /
CARPORT / TOTAL
1ST FLOOR / 2ND FLOOR /
/ BASEMENT FINISHED /
DECK / GARAGE /
/ HEIGHT TO PEAK OF BUILDING FT.
BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY SQ. FT.
IMPERVIOUS SURFACE SQ. FT.
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 GiG .,:,
DATE
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
Zip
$
Payer's Name
Address
City of SPOKANE VALLEY
Build' F'
Applicant/Business
Project Name
Site Address i..?V
BLD O.P. 23C
In ,treisntl_pcuplic Works FeesReceipt�Permit No.L3D _65_ 7/7
Date ‘43/ e)
/31"zIaG{ teary
Please Receipt the Following:
Check Number Receipt Number
BUILDING DEPARTMENT
001.059.322.10.01
001.059.322.10.02
001.059.322.10.03
001.059.322.10.04
001.059.322.10.06
001.059.322.90.01
001.059.345.83.01
001.059.345.83.03
001.059.342.40.02
001.059.237.10.98
001.059.237.10.02
FIRE DEPARTMENT #
001.059.322.10.07
001.059.322.10.08
001.059.322.10.09
001.059.322.10.10
001.059.322.10.11
001.059.322.10.12
001.059.322.10.13
001.059.321.30.00
001.059.342.40.01
001.059.237.10.99
OTHER:
City
Building Permit
Plumbing Permit
Grading Permit
Mechanical Permit
Demolition Permit
Misc. Permits and Fees
Plans Check Fee
Energy plans check fee
SPECIAL Inspections $
Bonds / Deposits
WSBCC Surcharge *
Plans check fee
Sprinkler plans check
F. A. Plans check
Misc. plans check
Fire Alarm inspections
Sprinkler inspections
Misc. inspections
Fireworks Permit
UFC permit fees
Bonds / Deposit **
PUBLIC WORKS
001.059.322.40.00 Right of Way $
001.059.342.40.03 Special Inspections $
001.059.237.10.99 Bonds/Deposits (cash)** $
TOTAL AMOUNT DUE $ 3 ,�_ 7 o
* To be sent to Wash. State Building Code Council quarterly.
# 65% of figure to be sent to the Fire Department Quarterly, except bonds etc.
* * Liability Insurance verification may also be required.
s-vb1d23c 4-21-03