2003, 05-02 Permit App: BD03-330 Detached GarageCity of
SPOKANE VALLEY
Box 1 OWNER c(,.o SS
PERMIT #a 3 - SSC
BUILDING PERMIT APPLICATION
�Nrs k\r--t� s�
OWNER'S ADDRESS
DESCRIBE JOB
JOB LOCATION N . "k l \o LAV ay. Q ,
CITY PHONE 011..c.t
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THIS PROPERTY IS OWNED BY: SINGLEMARRIED
PARTNERSHIP CORP. ��—
BOX 2 CONTRACTOR'S NAME v\t\,( S �� ov PHONE
CONTRACTOR'S ADDRESS
CONTRACTOR'S REG.#
BOX 3 CONTACT PERSON OF PROJECT
CITY
EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VEFIFIED)
S5 PHONE 9OV7 (7
ADDRESS CITY ZIPctA
BOX 4 SEWER AVAILABILITY'""`
'0 p
WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST $ , 000
EXISTING BLDG. VALUATION $
t
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
S" 011 . OH(
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR / OTHER
BASEMENT UNFINISHED /
CARPORT / TOTAL
1ST FLOOR / 2ND FLOOR /
/ BASEMENT FINISHED
DECK / GARAGE
/ HEIGHT TO PEAK OF BUILDING t l0 FT.
BOX 8 ( ) 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) NO oma.-. MECHANICAL APPLIANCES ;N ovw
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) 114 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 DATE (OVER)
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