2012, 07-03 Permit App: SVFD-2012-0080 Hydro Test A , Z
.,''= Community Development Department
►�CITY �s� Permit Center (Staff Use Only)
o iie 11703 SpokanEe Vast s y, WA 99206 Avenue,rague Suite B-3 PERMIT NUMBER:
Valley
Tel: (509) 688-0036
4000
Fax: (509) 688-0037 PERMIT FEE:
oermitcenter@lspokanevalley.orq .
i• — Wall
FIRE SAFETY PERMIT APPL 4•A) se, • N D
SITE ADDRESS: Ct'O/ 2— F , AIR .
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: JUL 0 3 2�9?_
BUILDING OWNER NAME: '% �� CSS/ PEt;(M11T CENTER
MAILING ADDRESS: /5 r' 3 F. iee, 2SUB # ; .-1
-1 H EV. #
CITY: 7, , - / STATE: ( ' --.,ig '=':. c, /G?7
CONTACT PERSON NAME: / ,r0-, -�'!-✓o
PHONE: q (- /Sys FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
NAME OF OCCUPANT OF STRUCTURE: /ter,,., /„p
PHONE: 9'q/-/51/5 FAX: CELL:
CONTACT PERSON NAME: /;, -, C 4,--�.,
PHONE: FAX: CELL:
FIRE SPRINKLERS: >• NUMBER OF HEADS: 3 /
FIRE ALARM: ,J/, . PAINT BOOTH: AK,/,
TENT: ) ,jj/4._ BLASTING: �/,�.
DATE/TIME: OTHER:
ABOVE/UNDERGROUND STORAGE TANK SIZE: /V/
DESCRIBE THE SCOPE OF WORK IN DETAIL:
TOTAL COST OF PRO]ECT: $ ,260-, C' � ' $ ` .
DISCLAIMER {�
The permitted verifies,acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwellirig,the%\ lifig is/will
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to represent the property owner in this transaction. 4) All construction is to be done 4'cprnpl rhewith the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Vallesy3'Rertal4tr ) 11 `Cfvc' p(
Spokane Valley permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Planis or attditorkal
information may be required to be submitted and subsequently approved before this application can be processed.
Signature ,--7----- �____-- Date: 7/3 b 2
Updated 1-11-11 Page 1 of 1
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