2003, 04-21 Permit: BD-03-154 ReroofV l/ L V/ L V V V V V. V V
APR 19 2903 16:5' FR
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SPOKANZ VALLEY
T09929717 P.O1/02
PERMIT #BDv3154
BUILDING PERMIT APPLICATION
THIS PROPERTY IS OWNED IIY: SINGLE/MARRIED
PARTNERSHIP • CORP
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SOX 2 CONTRACTOR'S NAME
CONTRACTOR'S ADDREst'C •
CONTRACTOR'S REO.
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BOX 3 CnNrAcr PERSON OF PROJECT PHONE ��\— (f),17
ADDRESS aif\(YL _Qa__SOAte. CRY ZIP
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90X 4 SEWER AVAILABILITY -- WATER AVAILABILITY
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BOX 6 ESTIMATED PROJECT cOST $ ^ EXISTING BLDG. VALUATION S
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BOX 6 PROPERTY TAIL AC4OUN'T NUMN!R _7
CITY
XPIM710N DATE 1�-
RESENTSD AND COPIH OR ERIE • )
LEGAL DESCRIPTION
0
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
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B OX 7 BUILDING SQUARE FOOTAGE (Existing / proposaml) 1ST FLOOR / 2ND FLOOR, /_
3RD FLOOR / OTHER / BASEMENT FINISHED I
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BVILDINO FT.
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BOX 9 (k() SINIR A PAMILY ( ) NEW CONYTRUCTION
( ) MULTIFAMILY (NO. OF UNITS ___ ) (y() EXISTING STRUCTURE
( I COMMERCIAL / INDUSTRIAL TOTAL AREA OF PROPERTY SO. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE BO. FT.
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SOX 9 PLUMBING PU(TUR5$ (Including roue -ins) MECHANICAL. APPLIANCES
PLEASE USE THE ATTACH PLUMBING / MECHANICAL FORM FOR THE LUSTING OF ALL APPLIANCES,
SYSTEMS, HEATING ANO AIR UNIT& FIREPLACE INSERTS. WATIIR HEATERS. CONVERSION BURNERS.
LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL.
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S OX 10 Water Service meter size (If known) Mao Sea BOX 4
BOX 11 9pUo Tana — Nb( 9900t90y IWo in to CIty of Spoken. valley. For sproi9( einUM ttlnoe. oonlaot
Tour sewer purveyor ono Ole Haw Omelet (Sss BOX 4)
B OX 12 SWIM um may "pure s ` Millet Use Perm ter sewer, *Msr, sklswrellw, cure outs. Contact the Public
Works Dspertrnsnt.
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED SY ME 16 TRUE AND
CORRECT TO Tse AWT OF MY KNOWLEDGE. AND PURI' T r AM AUTHOW?iD SY THE OWNER OF THE
ABOVE PRI NIAE9 TO PERFOtU& E WWfORRRK( FOR WHICH THE IS DE
OWNER /AGEM�� %6�•% 4A� DATE 7Z2 (OVER)
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APR 20 2003 07:52 1509E1929717 PAGE.02
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OFFICE USE ONLY - PLEASE 00 NOT WRITE BELOW THIS UNE
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ZONE SETBACKS: FRONT SIDE — REAR _ HEIGHT UMIT
PLANNING DEPARTMENT APPROVAL
REMARKS
D13APPROVAA, DATE
®EPA: EXEMPT NOT EXEMPT
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Fm DEPARTMENT APPRbVAJL _DISAPPROVAL DATE
REMARKS
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PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE
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TYPE OP JOS; NEW RESIDENCE _ RES. ADO/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL _ COMM. ALT/ADO NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADIXALT TENANT IMP. _ ROOF OTHER
OCCUPANCY TYPE OP CONSTRUCTION STORIES
BUILDING SQ FT.
BUILDING SG. FT.
;WILDING SQ. FT. A f
BUILDING SO. FT. {p
TOTAL. 50. FY. TOTAL VALUATION
BUILDING PERMIT NO. PLAN CHECK FEE RECD RECEIPT NUMBER
PERMIT PEE PLAN CHECK PEE PLUMBING PEE MECH. FEE _
TOTAL FEES WSECC SURCHARGE ENERGY SURCHARGE
omen, CMAROES AMOUNT DUE
BULDWG DEPARTMENT APPROVAL _ BY
A88IGNED ADDRESS
DATE
. 701"041.. PAGE. 112 ..
APR 20 2003 07:53 15098929717 PAGE.03