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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