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2003, 04-29 Permit App: BD03-303 Garage 46.ley vi HrN ell Cees i'+:! r r < <'/ 5--9" - iii t:)a44tUikJ r.Ud/14 SPOKANE VALLEY 50),go,j dt/, PERMIT# ©it-1,b BUILDING PERMIT APPLICATION = - --- ...._ _- s,--.-- ' Box 1 OWNER , i c JOB LOCATION L//3 s• S. : •4det is tI OWNER' ADDRESS SA,rd CITY `l1x.y PHONE, 5-1,9 y9/`40.5.? •v DESCRIBE JOB 3 O S'O pas-71J',i3O,,.,-.r — THIS PROPERTY IS OWNED BY:SINGLE/MARRIED PARTNERSHIP CORP, ==a=--= ========s===-s- ss: ===== =- =-=== =====__. e..._ BOX 2 CONTRACTOR'S NAME', iiv,I i L y /j/a _PHONE 5- -$3.5---- 70 14 CONTRACTOR'S ADDRESS ski,f F, A•7-,..� CITY Sg -r U4J/t , CONTRACTOR'S REG.#• to c' C�a EXPIRATION DATE 4 0 y (CARD MUST BE PRESENTED AND COPIED OR VERIFIED) _=.-w=s=s==a =______ ====a,�= __ =====sss=sse BOX 3 CONTACT PERSON OF PROJECT Kees L ami' PHONE _ ?S2_9o/e w„rt,�, V ADDRESSS9/ _L= ti,T CITY 5 A,..-r�Q/by ZIP 79;2/.2 =====W===o =_= ====== smisae===ase=====----=sssssa======= BOX 4 SEWER AVAILABILITY /10 __WATER AVAILABILITY— r-,r')• ==ss===as==----= ====-a-------======= Ma======== -......=saas=ms== BOX 5 ESTIMATED PROJECT COST$ i2 ,35j,(ye,EXISTING BLDG.VALUATION$_� ___ =ess==ssr___�-.==sea===m==�.�,-_a=== s_s===saes== ==ss==:saee____ == BOX 6 PROPERTY TAX ACCOUNT NUMBER -, '3-3.23 . /30 $' LEGAL DESCRIPTION (IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) CENSUS NUMBER LOT NUMBER —==s==e=as=== ======= rotas==-- e.__-... _______ ====aa==== BOX 7 BUILDING SQUARE FOOTAGE(Existing/proposed) 1ST FLOOR //TOO 2ND FLOOR 3RD FLOOR / OTHER ____ -"T BASEMENT FINISHED_ _../-_---/----- BASEMENT UNFINISHED / DECK- I GARAGE ,_, /L T&O CARPORT / TOTAL. /_ HEIGHT TO PEAK OF BUILDING /7-G� �FT, 'S=zsacosssssz= a=c==acss ========_--_---===a=====s====n----=rs=_ -- BOX 8 ( ) SINGLE FAMILY (7X) NEW CONSTRUCTION ( ) MULTIFAMILY(NO.OF UNITS ) ( ) EXISTING STRUCTURE ( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT. ( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE SQ. FT. _____________...__==s==ss===-•-•----__=====s = ==a= ---- _ 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. ==__ _- s-=e-=-----•-ax =a===ea=a=s========ss=====______=__ 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 T FORM THE WORK FOR WHICH THE APPLICATION IS MADE_ OWNER/AGEN (Ce-Ar-/e DATE "� 7,29 3 (OVER) I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card: Visa Meetercard �_,__ _—1_ _____ ____� Expiration Date Print the name of the Bolder Signature THIS A CERTIFIED COPY OF REGISTRATION FOR: TOWN & COUNTRY BUILDERS, INC. # TOWNCBI123C6 EXPIRES 06-30-2004 a;o. 'oN4 I REGISTERED AS PROVIDED BY LAW AS w�OTARk CONST CONT GENERAL •. - REGI ST. # EXP. DATE % • PUBLIC :o CCO1 TOWNCBI123C6 06/30/2004' ice• EFFECTIVE DATE 02/26/1988 ////j W �o``�� ` TOWN & COUNTRY BUILDERS INC '(,' j 5 918 E TRENT AVE r (1 _3< r' t; SPOKANE A 99212-1212 CINDY +LMSTEAD Signature i2Ji c } Issued by ► 'ARTMENT OF LBOR AND INDUSTRIES NOTARY FOR THE STATE OF WASHINGTON COUNTY OF SPOKANE MY COMMISSION EXPIRES ON 01-08-2005 ir—_—Th. _— • / 0( ,„ — AP P R.' ED DI etdo • W ct. __________\ / / / 4 _. ,, . ' ;(46 / : , i 7 . (.... 11, / co . \ i 1 13 .i . 1 /14 i j: 1 As% ,:," , / / fl a \ i ,,, / i , 1 , . 12. ..,.,, • 1 1 i .' , I \V - .-„---- „. ,/,/ \ ,° .•• \ - / / fiok3e_ - Li 0/ Po , ,, sr j / I / V 3 1 VG' (ea •. 1 .1\ e'•i' -' 1:------;--- --::::71 ,,, 1 , LA -.:-.1 1 / • .,,.... -- *1. i k' ,i) ' k , f' ;:1 , -----------__ ) Ct.11 j 4 S et e ,p �'" � / d Fiw r 4,fa aela/ S:-/p2 3 /ii�i'