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Mechanical Sub-Contractor: Contractor’s License:
Plumbing Sub-Contractor: Contractor’s License:
The permit becomes null and void if work or construction authorized by the permit is not commenced within 180 days of
issuance or if construction or work is suspended or abandoned for a period of 180 days at any time after work is
commenced, unless an extension is granted. Issuance of this permit does not give the authority to violate any federal,
state, or local laws or ordinances, or the building code regulating construction. Separate permits (building, plumbing,
mechanical, sewer, water connection, electrical, etc.) may be required for work performed on this site. Additional permits
/plans may be required prior to Certificate of Occupancy issuance. Contact SRCAA at 509-477-4727 and/or visit
www.spokanecleanair.org to ensure compliance with air quality regulations.
The applicant shall be responsible for
obtaining additional permits/approvals from affected agencies. By checking the box below, I certify that I have read and
understand all of the conditions contained herein and I have the authority to sign on behalf of the applicant. Additionally, I
certify that my signature included on the permit, if done by electronic means, provides the same understanding and
authority as if I had signed the permit in person or writing.
BY SIGNING BELOW (WITH ELECTRONIC SIGNATURE OR PHYSICAL SIGNATURE), I ACKNOWLEDGE THAT A MINIMUM OF 24
HRS. NOTICE IS REQUIRED FOR ALL INSPECTION REQUESTS. I ACKNOWLEDGE THAT I HAVE READ AND ACCEPT THE
REQUIREMENTS LISTED ABOVE AND BELOW. I GIVE PERMISSION FOR USE OF MY ELECTRONIC SIGNATURE ON THE
PERMIT AND I ACKNOWLEDGE, UNDERSTAND AND AGREE TO THE TERMS DESCRIBED ON THIS APPLICATION.
Property Owner's Signature Printed Name Date
Applicant's Signature Printed Name Date
Before beginning renovating or remodeling activities in pre-1978 residential buildings or child occupied facilities, contact
the Washington State Dept. of Commerce Lead Paint Program at (360) 586-5323, visit www.commerce.wa.gov/lead, or
email the lead program lbpinfo@commerce.wa.gov to ensure compliance with applicable Washington lead regulations.
BUILDING INFORMATION (PLANNING, ENGINEERING & BUILDING SERVICES OFFICE USE ONLY)
# of Stories: Peak Height: Total Habitable (sq. ft.):
Main Sq. Ft.: Upper Sq. Ft.: Lower Sq. Ft.: Other Sq. Ft.:
Fin. Bsmt. Sq. Ft.: Unfin. Bsmt. Sq. Ft.: Deck Sq. Ft.: Cov. Deck Sq. Ft.:
Garage Sq. Ft.: Acc. Sq. Ft.: Occupancy Group: Construction Type:
Water Purveyor: Sewer Purveyor: Fire District: School District:
Front Setback: Rear Setback: Right Side Setback: Left Side Setback:
Lot Coverage %: Zoning: Other Mitigation / Impact Fee Area:
PROJECT VALUE: Notes
Building Permit Fee:
Plan Review:
Harvard Road Mitigation Fee: $671.02
SBCC Fee: $6.50
Plumbing Fee: $120.00
Mechanical Fee: $200.00
Processing & Technology Fee $40.00
Total Permit Fees:
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