2003, 06-19 Permit App: BD03-657 Garagea,iey qr
SPOKANE VALLEY
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PERMIT # jib 03 -• (a,S
BUILDING PERMIT APPLICATION
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Box I OWNER / O&(f' /'12/E.e / JOB LOCATION /e)t✓o,`
OWNER'S ADDRESS Uaoei CITY S.W.. PHONE CO/ 4ax._c
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DESCRIBE JOB X,'c fo se
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED £obe✓+ 01 G 1
. PARTNERSHIP CORP,
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BOX 2 CONTRACTOR'S NAME Tow., 4-w /3tC')de✓s. PHONE (soh) r3s 9 c (,
CONTRACTOR'S ADDRESS 4-9 /9/ /5- Trc.t't CITY SrbEt:„,.�
CONTRACTOR'S REG.# T� ow C4/ -/tic (. EXPIRATION DATE - (o - 0 y
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
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BOX 3 CONTACT PERSON OF PROJECT PHONE
ADDRESS CITY ZIP
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BOX 4 SEWER AVAILABILITY Ye- 5 WATER AVAILABILITY V c S
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BOX 5 ESTIMATED PROJECT COST $ /2 Co 'EXISTING BLDG. VALUATION $
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BOX 6 PROPERTY TAX ACCOUNT NUMBER H S 3 3 3 / 201
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER`T LCT NUMBER
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BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR ) 300 /--2ND'FL'OOR /
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL
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HEIGHT TO PEAK OF BUILDING 40 I FT,
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BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
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,('NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY / JOU SQ. FT.
IMPERVIOUS SURFACE _ SQ. 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 (W known) Also see BOX 4
BOX 11 Septic Tank - Not generally allowed in the City of Spokane Valley. Fur 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 fee for this permit to sty credit card:
Vba Mastercard Expiretion Date
Print the Herne of the Holder
Signature
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