2003, 06-27 Permit App: BLD-03-02001 Reroof •
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City o f Phone 688-0036
SPOKANE VALLEY FAX 688-0037
Inspection 688-0054
PERMIT #
BUILDING PERMIT APPLICATION
B x 1 OWNER S6� pJ 4-11AL/Al JOB LOCATION
OWNER'S ADDRESS X19/, ti i(5-ns PP CITY Va/ e --- . ST.I(lfl PHONE qa l�-tea i 1DESCRIBE JOB i� en(�� i n f-fo�( c,t-
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED /t'( PARTNERSHIP CORP.
BO 2 CONTRACTOR'S NAME S PHONE
CONTRACTOR'S ADDRESS CITY
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT S 6-7,4 0 /- 1.-\%-/ it)
f /4 PHONE g 9.6G - s 1 -7
X., ADDRESS 4. 11 b N 2., FS /Z 0 CITY VC 11 2 ' W/ ZIP Q G! ,/ 6
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
$BOX 5 ESTIMATED PROJECT COST$7vD. EXISTING BLDG.VALUATION $ q0/ o'o.
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) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING FT.
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT.
( ) TENANT IMPROVEMENT 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 DATE (OVER)
s-vappbp 4-16-03