2003, 06-16 Permit App: BD03-613 GarageCity of Spokane Valley
11707 East Sprague Avenue, Suite 106
Spokane Valley, WA 99206
PERMIT# PDc3-Lel -2)
BUILDING PERMIT APPLICATION
PHONE (509)688-0036
FAX # (509)688-0037
Box 1 OWNER �Zh JOB LOCATION I k Z Z 13..)c erye
OWNER'S ADDRESS CITY PHONE
DESCRIBE JOB P3 `C- S I e- 'k.1 cit a �C
al jc Zq) l�
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED X
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME M A
Wlr I (3vi(�'s PHONE 2. Fs-Z?r�i
CONTRACTOR'S ADDRESS S.1 2-3 1,/ (.ee41( Let. c' s.CITY 3e, e -
CONTRACTOR'S REG.# ►fi x W► E `1 7t)C8 EXPIRATION DATE 2-/ L4/0S-
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT IAA -4-x- PHONE
ADDRESS ' 3.o- n c e_ CITY o
ZIP Tl'j 20 "3 -
BOX 5 ESTIMATED PROJECT COST $ 7vO =� EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR / OTHER
1ST FLOOR ( / s 71' 2ND FLOOR /
/ BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING / `Y
FT
BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY
IMPERVIOUS SURFACE
9 �3
9.50
SQ. FT.
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"'7' 1-''-,L�- DATE / -03
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
l\72f3,Jc..4 ere
APPROVED BY