2003, 04-10 Permit App: BD03-057 GarageCity of
SPOKANE VALLEY
PERMIT # 61) t)' - 05 -2
BUILDING PERMIT APPLICATION
Box 1 OWNER $ /EUU� B/9g(eLS
OWNER'S ADDRESS S 7�„p -CITY
d ( (
DESCRIBE JOB
JOB LOCATION % % L( 2( E 9 a S / _f ("Le_
PHONE C' YAC. V-14' ??0? -
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED 51't--.
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S ADDRESS
CONTRACTOR'S REG.#
PHONE
CITY
EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT SPHONE if -0%13' `%
ADDRESS CITY ZIP
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY (64..)‘--..i>
BOX 5 ESTIMATED PROJECT COST $ OOO EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
1ST FLOOR /60 2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED
BASEMENT UNFINISHED / DECK
/ GARAGE
CARPORT / TOTAL /
/
0
HEIGHT TO PEAK OF BUILDING / a FT.1
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 I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO PE RM TJE WO'K FOR WHICH THE APPLICATION IS MADE.
OWNER / AGENT
DATE 63 (OVER)
H
LOT )15 x 115
1 2.
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