2003, 07-22 Permit App: BD-03-858 Pole Shopity of Spokane Valley PHONE (509)688-0036
FAX # (509)688-0037
707 East Sprague Avenue, Suite 106
okane Valley, WA 99206
PERMIT # 4 .0" OS " 3
BUILDING PERMIT APPLICATION
Box 1 OWNER}km, b /i9-.6 // JOB LOCATION "7'7/'7 A,1 ida.TY
OWNER'S ADDRESS fni; CITY PHONE L/ /
DESCRIBE JOB ,_C,` X (r)
THIS PROPERTY IS OWNED BY: SING / ARRIED� � �CI, irJ � v ,1 11 12��t
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME
//2
PHONE
CONTRACTOR'S ADDRESS CITY
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT /+% c)g- Mali/ A ni,JN-PHONE
ADDRESS�17/ J7 _ / / CITY'_ /9AJ ZIP �% �i /
=T=i_-=may==��
BOX 5 ESTIMATED PROJECT COST 1/5OO, 0'7 EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER$ Lin DE i /4 e /T (EL 4 Sr4 8
LEGAL DESCRIPTI N
..
_ kc b -fi 1/F _ b cr ,csa fr Cif 5/SA a Fr tF7l2 a
1
1ST FLOOR actin 2ND FLOOR /
BASEMENT FINISHED /
DECK / GARAGE /
BOX 7 BUILDING SQUARE FOOTAGE (Existing /
3RD FLOOR / OTHER
BASEMENT UNFINISHED /
CARPORT / TOTAL
roposed
/ HEIGHT TO PEAK OF BUILDING FT.
30X 8 ( SINGLE FAMILY
( .) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
( .---(NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERT/ �%0
Y 1p SQ. FT.
IMPERVIOUS SURFACE SQ. FT.
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
,BOVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
►W NER / AGENT P 11, �% r DATE 17 `
hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard . — _ — _ Expiration Date
Print the name of the Holder
Signature
f 0-1,-Nrt
0/
/4\
U!/LJ/LUUJ U7.UJ JU7JL41JO/
JUL 19 2003 17:15 FR
Jr\flU CMJ
TO 3241567 r. ed%aZ`
ity of Spokane Valley
707 East Sprague Avenue, Suite 106
Dkane Valley, WA 99206
PEXRNZXx' # �• C�:-� 5
DIDIDING PERX'X' APPLICATION
PHONE (509)688-0036
FAX # (509)688-0037
Box 1 OWNER rJOB LOCATION "7'7/ii . ,1 k`Y
OWNER' ADDRESS : ,,g CITY .•. PHONE 14j.- ga /
DESCRIBE JOB S X ( P
1HI5 PROPERTY IS OWNED BY: SING
PARTNERSHIP CORP.
MEALY /n4A-s.i1
_=aweswm.—sp■=—_ _ �— .—aoe■aelcr--91■a�—fix== 3mC__ —_ _]t■�s�—�c7C==
BOX 2 CONTRACTOR'S NAME PHONE
PHONE
CONTRACTOR'S ADDRESS CITY
CONTRACTOR'S REG.# ,EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
=BOX
.,._a■==—----.sY- --.,-...........=�e.�_ _� =—__®■. ---
BOX 3 CONTACT PERSON OF PROJECT DA- M y 'd/1 /H -PHONE �'� / •
AOORESS'71 r7 4. - • i1/ CITY E_______ ZIP 4,47A / A
=11a6== otam■ol�aasr_—^sc_----- -"a.m======• =ilii===—=4as==..==..r-- sty=----_
3OX 5 ESTIMATED PROJECT COST SWODS D -r) EXISTING BLDG. VALUATION $ • , • •• • --•
s.- -■ =-- ===. ____ = - ==._.-
30X a PROPERTY TAX ACCOUNT NUMBS x CIP,�f t0 i
LEGA DESCRIPTI N
G • : �► D al Fr of SSS' Df , , , Sts , a,s-- 0F7/2 a
.---r--_—=■.sem— �.._•..._s.,��---"'st-.�=---=�"'m-'—=_d�y���r,,�,.._�-•�.-._-=�=�c-----
1ST FLOOR _ r 2ND FLOOR. /.
30X 7 BUILDING SQUARE FOOTAGE (Existing i
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / • DECK / GARAGE /
CARPORT I TOTAL / HEIGHT TO PEAK OF BUILDING FT.
!i•— —5 s= • =311■CL= -.T �"�' =,11=_.`Jt33S—rr IC=== –== 11== =JAp■■R`=
( .-"ANEW CONSTRUCTION
TOTAL AREA OF ROPERTYriING STRUCTURE ,7 / ?I 3 � SQ. FT.
IMPERVIOUS SURFACE SQ. FT.
IOX 8 ( j. SINGLE FAMILY
( .) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL 1 INDUSTRIAL
( ) TENANT IMPROVEMENT
�■.e=—_ yam-�.�smrs---��=—.�a:s us.■��-_-='°■ear
/ERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE
DRRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY:THE OWN
30VE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
NNER/AGENT _ DATE 7 `ga-a
hereby authorize the City of Spokane Valley to cherne the fee for this permit to my credit card:
Ise Mastercard �.--- _..._ __ ---- Expiration Date
rintthe name of the Holder _ _ Signature
JUL 20 2003 09:06
F THE
5093241567 PAGE.01
07/23/2003 0`J:' b 5b'ddZ41Ob/
JUL 19 2003 17:15 FR
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TO 3241567 P.03iO4
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JUL 20 2003 09:06
APPROVED 9Y
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5093241567
PAGE.02
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APPROVED BY
7-, 2
1POKANE COUNTY NLALTN DEPARTMENT
E.O.PLOEGER,M.D. ,M.P.H. , Health -Officer
Division of Sanitation
N. 810 Jefferson Street
Spokane, Washington 99201
�l a9.2z.
PERMIT NO
Name
DATE L 79
NAA 03019
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSALFACILITIES
Address of Proposed Site
w
Type of Use L� �--� - /L�� .uilding planned)
Number of Bedr ns il 1ding Capacity Camp Capacity
Water Supply (City, Well, Spring). Drywell
Septic tank capacity 7s- 6 gals. Style of tank
Length of disposal field /,..c 6 Absorption Pits Leach Bed
Other
(1) Show relative local .ol':g ;rppQsed house, septic tank,
disposal field, vr>'"llrv..(] plca e-a�3"tl aEt r}Fj ut buildings.
4"IlJ�ywow 7i..
gravel 4.44
(2) Make note of ar " q. v�rp'glefrl viampy area or any
other important to YB toagtAir s 11
wu
9ab2°Gij
cip
Installer
3
Final Inspection D
Remarks.
CONTRACTOR
FORM 346 6EV.MEALTM
1 • . , • I, 1 -
• • e-. (VI M
For Spokane County Health Department
W