2003, 04-04 Permit App: BD-03-034 RampCity of
SPOKANE VALLEY
PERMIT # 1jb 03-03d
BUILDING PERMIT APPLICATION
BOX 1 OWNER�rxa.,aconh (�,/�.n42i,i/cdokiJOt+3 LOCATION 13,,,c.(S4e,2 et Apia!,cu,2i git.
OWNER'S ADDRESS 2(q ./ 5 ,,/c.QITY PHONE .4e6 'R. 25'
DESCRIBE JOB r - . „ 6, I RF,
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTORS NAME PHONE X ,- - 3t, z 5 -
CONTRACTOR'S
CONTRACTOR'S ADDRESS CITY
CONTRACTORS REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT CS ee Li /41 e_ I PHONE q 211- /3O8
ADDRESS (QO24 E elxeic, CITY eZiLC/Ze-5 ZIP alv.
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST $ 2ryr,0 ` 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 / 2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING FT.
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL / INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT.
( ) TENANT IMPROVEMENT 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 PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER / AGENT DATE a (OVER)
Spokane �`�
0„0valley
CITY OF SPOKANE VALLEY
11707 E. SPRAGUE, S IE 106
SPOKANE VALLEY, WA 99206
SITE INFORMATION
PROJECT TRANSMITTAL:
TRANSMITTAL DA1'E: !1_y D3
PROJECT INFORMATION
Site Address: 02/5- A) 6RLke
Cmr,e.er,etare LOA 9g04.49
Parcel Number:
Subdivision:
Block: Lot:
Zoning: Water Dist:
Owner: 'reeacre s cAirt5f�ccn
Address: &Lile. er
C,re encare 3
Building Inspector:ra
F-e/ku.56
I-
T -reject Number: $ b 03.. 034 Issue Date: (//4/03
Permit Use:
Aeaess 4,rnp rot
urc k
Applicant: Q( in p 1'
Phone:
Contact: e2'ex L nd-Q � I
0c -
Phone: 27_ 136?
Setbacks — Front: Left: Right: Rear:
APPROVALS
BUILDINGS:
PLANNING:
ENGINEERS:
SEWER/SEPTIC:
FIRE DIST. in:
OTHER.
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