2003, 08-01 Permit App: BLD-03-02119 PoolJUN 23 2003 12:53 FR
:ity of Spokane Valley
1707 East Sprague Avenue, Suite 106
Dokane Valley, WA 99206
TO 4870092
PERMIT #
BUILDING PERMIT APPLICATION
P.01/01
PHONE (509)688-0036
FAX # (509)688-0037
MINN
Box 1 OWNER C VantIlA Lr. 1-411K64.19 JOB LOCATION
OWNERS ADDRESS C PHONE-- S?v'7>.
3 �'a 2. SGo�,�th Spolca tte. 2x•6
DESCRIBE JOB -
THIS PROPERTY IS OWNED BY: SINGLEIMARRIED _✓
PARTNERSHIP CORP.
SOX 2 CONTRACTOR'S NAME 4�A.v{liQv,,. ?OM PHONE 4 81-0i0({ �_�....
CONTRACTOR'S ADDRESS J)L 106144
CITY %rye (4)# 90-n7
7
CONTRACTOR'S REG,,#_P%1 .ViW94bS EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT i A - �J - _ RHONE 487-0/0i
ADDRESS )10i-Wist CITY LatilP,;DA ZIP 9q?/1
T -
BOX E ESTIMATED PROJECT COST $ 14000:-:- EXISTING BLDG. VALUATION $• .-..-
r. �sa_....��
BOX S PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
-= _ =
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR /2ND FLOOR I
3RD FLOOR _ / OTHER J
. BASEMENT UNFINISHED /. DECK
. CARPORT / TOTAL /
BOX 8 ( ) SINGLE FAMILY
( . ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
BASEMENT FINISHED
! GARAGE /
HEIGHT TO PEAK OF BUILDING FT.
==.—._ -_ = --z m
NEW CONSTRUCTION
EXISTING STRUCTURE •
TOTAL AREA OF PROPERTY
IMPERVIOUS SURFACE
SQ. FT.
SQ. FT.
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND • •
:ORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
4BOVE PREMISES + PE 0- . THE WORK FOR WHICH THE APPLICATION IS MADE. •
OWNER 1 AGENT , �! . DATE '
Ihereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card;
Pisa Mastercard _ ` _^ r .. _ r — _ _ ._._ _ — Expiration Date
Print the name attire Hoiden -- - Signature
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