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2003, 04-08 Permit App: BD03-044 GarageCity of SPOKANE VALLEY PERMIT # R 03'0(1� BUILDING PERMIT APPLICATION Box 1 OWNER /1c1 f i) fJ'' JOB LOCATION F 15,)0 /3 cxp OWNER'S ADDRESS //cW r 'CITY Gj2**ice PHONE gay -Som DESCRIBE JOB QoI e 13vlcl,t� THIS PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME /tele( Pr CONTRACTOR'S ADDRESS CONTRACTOR'S REG.# JI 9d-0 f ckeJc' PHONE Idy-S CITY 7pok41,1e EXPIRATION DATE (CARD MUST BE PRESENTED AND COPIED OR VERIFIED) BOX 3 CONTACT PERSON OF PROJECT cl Fai' PHONE 5a1/`So ADDRESS 11.90 /14-)c-1( i e CITY %, flYM) ZIP5 (© BOX 4 SEWER AVAILABILITY WATER AVAILABILITY BOX 5 ESTIMATED PROJECT COST $ 5-0OO EXISTING BLDG. VALUATION $ BOX 6 PROPERTY TAX ACCOUNT NUMBER LEGAL DESCRIPTION 6-691,)Q5-?, (IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) CENSUS NUMBER LOT NUMBER BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR gi(o / 2ND FLOOR / 3RD FLOOR / OTHER / BASEMENT UNFINISHED / DECK CARPORT / TOTAL / BASEMENT FINISHED / GARAGE HEIGHT TO PEAK OF BUILDING 1') 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. BOX 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. BOX 10 Water Service meter size (if known) Also see BOX 4 BOX 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) BOX 12 Street use may require a " Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public Works Department. 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 1 AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THh WfE RK FOR WHICH THE APPLICATION IS MADE. DATE —6- 6?, (OVER) OWNER / AGENT .v