2003, 06-06 Permit App: 03-285 SidingCity of
SPOKANE VALLEY
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PERMIT # 03,'Z.15 -
BUILDING PERMIT APPLICATION
68Y -D(05 ‘)
FFIx 6 0 37
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Box 1 OWNER 1-0 4/V Stiff JOB LOCATION r) 0/ 7 /..(Z7 /1AP 124 2:0
OWNER'S ADDRESS 2_017 CITY 221_4_ PHONE 'Zit. z-s.y.
DESCRIBE JOB £ rue 6-/ S/ -cad
THIS PROPERTY IS. OWNED BY: SINGLE/MAR
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME %'1`w7L , Ave- /5,14 s --
CONTRACTOR'S
CONTRACTOR'S ADDRESS
PHONE (Sbt' 276--707S-
$ I C8 w / trai i M CITY a.o7 %m'� 4 79o06
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX3 CONTACT PERSON OF PROJECT c2 4G cl PHONE 5-0 ? " ?ZZ --
Ce --/S /O
ADDRESS n4rf,e7eA CITY 5440„ ZIP ' ,92rZ
WATER AVAILABILITY
BOX 4 SEWER AVAILABILITY
-
BOX 5 ESTIMATED PROJECT COST $ 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)
3RD FLOOR / OTHER
BASEMENT UNFINISHED / DECK
CARPORT / TOTAL /
1ST FLOOR /
2ND FLOOR /
/ BASEMENT FINISHED /
/ GARAGE /
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 (OVER)