2003, 06-25 Permit App: BD03-704 ReroofCity o f
SPOKANE VALLEY
Phone
FAX
Inspection
PERMIT #4 -DQ ? - 70
BUILDING PERMIT APPLICA ION
688-0036
688-0037
688-0054
Box 1 OWNER Gita Z/,�- JOB LOCATION /00Z/9 e. /Yl,'S$,dl/
OWNER'S ADDRESS /0a/9 .*.ychr,..-CITY *Hh'n,t/ ST/.44- PHONE 953-6948
DESCRIBE JOB ,{/2W Rao
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED 7( PARTNERSHIP
CORP.
BOX 2 CONTRACTORS NAME
CONTRACTOR'S ADDRESS
CONTRACTOR'S REG.#
PHONE
CITY
EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT
ADDRESS
CITY
PHONE
ZIP
BOX 4 SEWER AVAILABILITY
WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST $ 4/,000 EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLIOOR /
BASEMENT UNFINISHED
CARPORTA /
OTHER
TOTAL
1ST FLOOR /
BASEMENT FINISHED
2ND FLOOR /
DECK / GARAGE /
HEIGHT TO PEAK OF BUILDING
FT.
SINGLE FAMILY
MULTIFAMILY (NO. OF UNITS
COMMERCIAL / INDUSTRIAL
TENANT IMPROVEMENT
( ) NEW CONSTRUCTION.
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY SQ. FT.
IMPERVIOUS SURFACE SQ. FT.
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.
BOX 10 Water Service meter size (if known) Also see BOX 4
BOX 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)
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 ar DATE (may ZC/C, 3 (OVER)
s-vappbp 4-16-03