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2003, 05-13 Permit App: BD-03-404 Fire Restoration
City of SPOKANE VALLEY (0W- 003p lia)( PERMIT # b q BUILDING PERMIT APPLICATION Box 1 OWNER cLs.) JOB LOCATION OWNER'S ADDRESS CITY PHONE °—? wt.( VeSA} (2-� DESCRIBE JOB THIS PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME .c -) Q AtsS PHONE c7S-? CONTRACTOR'S ADDRESS--Lk-2- CITY c)6SCJ CONTRACTOR'S REG.#e(4C_((ki, EXPIRATION DATE (CARD MUST BE PRESENTED AND COPIED OR VE" IFIED) BOX 3 CONTACT PERSON OF PROJECT PHONE G-7 --SS ADDRESS2 2e,, (t L0c—L.. CITY ZIP ` ck.2ks- BOX 4 SEWER AVAILABILITY WATER AVAILABILITY BOX 5 ESTIMATED PROJECT COST $ (--ES©b EXISTING BLDG. VALUATION $ BOX 6 PROPERTY TAX ACCOUNT NUMBER L(0 3 t-Fy- LEGAL DESCRIPTION r FGLr-5 1. (IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) • CENSUS NUMBER LOT NUMBER 30X 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. 30X 8 I —)--SINGLE FAMILY MULTIFAMILY (NO. OF UNITS ( ) COMMERCIAL / INDUSTRIAL ( ) TENANT IMPROVEMENT ( ) NEW CONSTRUCTION ( ) EXISTING STRUCTURE TOTAL AREA OF PROPERTY �ISQ. FT. IMPERVIOUS SURFACE SQ. FT. 30X 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 OX 10 Water Service meter size (if known) Also see BOX 4 OX 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) DX 12 Street use may require a " Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public Works Department. /ERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND DRRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE 30VE PREMISES TO PF FORM T RK FOR WHICH THE APPLICATION IS MADE. NNER / AGENT DATE G e 3-05OVE -05(OVER)