2003, 10-29 Permit App: BLD-03-02941 GarageHYN b1 c✓Jtt. 14 _,f rK
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SPOKANE VALLEY
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PERMIT #
BUILDING PERMIT APPLICATION
Box I OWNER Lee t u r ass JOB LOCATION Pi, 1109 Fc -h+5
OWNER'S ADDRESS 3I.le�.0 CITY q4 Ma PHONE CLOT) ytg_?.o3o
DESCRIBE JOB 30'k1,1‘ XI O." past' ern.. + h,,;ld:..<
THIS PROPERTY IS OWNED BY: SINGLE/dARRIEDD 1-'
PARTNERSHIP CORP.
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BOX 2 CONTRACTOR'S NAME hr. n s ("epRtry-R..014lers
PHONE S3S—kolb
CONTRACTOR'S ADDRESS 5918 E. frt.. - CITY_ itkt...e 04. RGe111
CONTRACTOR'S REG.# I0 ,.,,, LRT 1134_(.o EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
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BOX 3 CONTACT PERSON OF PROJECT I<s.,n c Coon>}+Y PHONE
ADDRESS CITY ZIP
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BOX 4 SEWER AVAILABILITY v' yr 4,.6. -t{ WATER AVAILABILITY
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BOX 5 ESTIMATED PROJECT COST $ 300o0 EXISTING BLDG. VALUATION $
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BOX 8 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
�1SI11.0403
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
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BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR / OTHER /
BASEMENT UNFINISHED / DECK
CARPORT_ / TOTAL /
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BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
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1ST FLOOR -3310/ 2ND FLOOR /
BASEMENT FINISHED
I GARAGE _._/
HEIGHT TO PEAK OF BUILDING IS '(o FT,
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( NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY SQ. FT.
IMPERVIOUS SURFACE SO. FT.
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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.
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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 end 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)
1 hereby authorize the City of Spokane Valley to charge the foe for this permit to my credit card:
Visa Mastercard Expiration Date
Print the name of the Bolder
Signature
Y n el 45-1/1.0403
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