2003, 05-19 Permit App: BD-03-458 Fire Damage RepairCity of
SPOKANE VALLEY
Box 1 OWNER
OWNER'S ADDRESS
DESCRIBE JOB4lie
(0W- 003
(( - 0037
PERMIT # /D- (5 -
BUILDING PERMIT APPLICATION
JOB LOCATION
PHONE
THIS PROPERTY IS OWNED BY: SING[(/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S ADDRESS 64 l:
CONTRACTOR'S REG.#
30X 3 CONTACT PERSON OF PROJEC
ADDRESS CP
PHONE
CITY
EXPIRATION DdTE
ARD MUST r_CRESENTED AND COPIED OR VE ` IFIED)
30X 4 SEWER AVAILABILITY �c,� W ER AVAILABILITY
PHONE
ZIP19)e93
30X 5 ESTIMATED PROJECT COST $ EXISTING BLDG. VALUATION $
30X 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
• CENSUS NUMBER LOT NUMBER
OX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR / OTHER
BASEMENT UNFINISHED /
CARPORT / TOTAL
1ST FLOOR /ZJ 2' / 2ND FLOOR
/ BASEMENT FINISHED /20
DECK / GARAGE
HEIGHT TO PEAK OF BUILDING FT.
DX 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.
)X 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, CONVERSI N BURNERS,
LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL:
X 10 Water Service meter size (if known) Also see BOX 4
X 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)
X 12 Street use may require a " Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
RIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND •
RRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
AVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
NER/AGENT
DATE (OVER)