2003, 06-26 Permit App: BD-03-713 PoolJUN 23 2003 12:53 FR
:jty of Spokane Valley
1707 East Sprague Avenue, Suite 106
aokane Valley, WA 99206
TO 4870092 P.01/01
PERMIT #
BUILDING PERMIT APPLICATION
PHONE (509)688-0036
FAX # (509)688-0037
Box 1 OWNER . ji•A (; a JOB LOCATION SAKI AS ow iu-'s ao p S 5
OWNERS ADDRESS .116i,t PHONE 1-175 - Isya
gIto SUEl-1-Y LAKE („ANS
DESCRIBE JOB in - a
THIS PROPERTY IS OWNED EY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME PPv1.L.. _��� \ PHONE / 7- Ui ay
CONTRACTOR'S ADDRESS C.oS E ttout-A•NO Sb 11-6 20Z CITY SPoicer* 972/
CONTRACTOR'S REG,# PPV ILP - 4-141 EXPIRATION DATE 211109
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT K T,A jw PHONE 4 E 7 - 0/0 y
ADDRESS Go S E CITY SPoleA ZIP 9921$ •
BOX 5 ESTIMATED PROJECT COST $ /`%Ono EXISTING BLDG. VALUATION $ _
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
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
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL,
( ) TENANT IMPROVEMENT
(X) NEW CONSTRUCTION Sw l r S po-t5 L
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY SQ. FT.
IMPERVIOUS SURFACE SQ. FT.
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
ROVE PREMISES TO PER ORM THE WORK FOR WHICH THE APPLICATION IS MADE.
DWNER !AGENT Q � _ _ DATE ( (O ` '(4) T3
'hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card: ,
Visa. Mastercard _ —_ r _ _ ., ._ — Expiration Date _
Print the name of the Holder SLgna
** TOTAL PAGE.01 **