2003, 07-08 Permit App: BLD-03-02027 Garage ;ity of Spokane Valley PHONE (.509)688-0036
1707 East Sprague Avenue, Suite 106 FAX # (509)688-0037
Dokane Valley, WA 99206
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 OWNER W�,,P `�G 4-�S�‘-‘ JOB LOCATION C ,,. }
OWNER'S ADDRBSS574(2.?.,i CITY PHONE G'2,
DESCRIBE JOB vZ�)
THIS PROPERTY IS OWNED BY: SINGLE/ ARRIED -
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME ( PHONE
CONTRACTOR'S ADDRESS CITY
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT `, P e PHONE
ADDRESS CITY ZIP
BOX 5 ESTIMATED PROJECT COST-17Q L /EXISTING BLDG.VALUATION $ __ _
BOX 6 PROPERTY TAX ACCOUNT NUMBER cie s"."--, . Z Q
LEGAL DESCRIPTION
BOX 7 BUILDING SQUARE FOOTAGE(Existing/ proposed) 1ST FLOOR / 2ND FLOOR
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /e%?
CARPORT / TOTAL tyhV l HEIGHT TO PEAK OF BUILDING 2O /OFT.
BOX 8 ( ) SINGLE FAMILY (>4) NEW CONSTRUCTION
( . ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE_ SQ. FT.
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 PERFO THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT /l DATE g°1---
I
�I 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
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