2003, 07-28 Permit App: BLD-03-02088 Storage Bldg .� Ht'N L11 c'.1::31:3.:514 �'r rK ` � i 11_1 .5,5403.0 F'.L1c2./
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SPOKANE VALLEY
PERMIT#
BUILDING PERMIT APPLICATION
Box 1 OWNER Czar ScLeAkte JOB LOCATION sfacikLe,e ►fc.k kft
OWNER'S ADDRESS 131..17 E. '-I"' CITY SPw g-e PHONE ebb-8 '
DESCRIBE JOB 2,1-l\..Y 30'X tv'b. post 5+(eP ...1ZuWenS
THIS PROPERTY IS OWNED BMARRIED
PARTNERSHIP COR..
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BOX 2 CONTRACTOR'S NAME i � ('6\3,4f), ;trite,3 PHONE Sol 5-3s ctdi6
CONTRACTOR'S ADDRESS S5/8 �, !i CITY /4c..--P Lf4
CONTRACTOR'S REG.# To wNc 2I 1.135,(• EXPIRATION DATE (9.-021
(CARD MUST BE PRESENTED AND COPED OR VERIFIED)
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BOX 3 CONTACT PERSON OF PROJECT_"_1(1- t �,�dry PHONE 515-g0r
ADDRESS CITY ZIP
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BOX 4 SEWER AVAILABILITY WATER AVAILABILITY_
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BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG.VALUATION$
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BOX a PROPERTY TAX ACCOUNT NUMBER `(.SSI • q 1
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
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BOX 7 BUILDING SQUARE FOOTAGE(Existing/proposed) 1ST FLOOR 1� / 2ND FLOOR /
3RD FLOOR I OTHER / BASEMENT FINISHED
BASEMENT UNFINISHED /____ DECK / GARAGE
1
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING I LI FT,
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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.
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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.
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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 e Street Use Permits for sewer,water,sidewalks,curb cuts.Contact the Public
Works Department,
I VERIFY UNDER THE PENAL •F PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF NOW EDG Nb FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO PER •RM STH DF;I OR WHICH THE APPLICATION IS
OWNER/AGENT ,y•- /
DATE - (OVER)
1 hereby authorize the City of Spokane V tel cy to charge the fee for this permit to my credit card: -+
VL+a Mastercard --.� ---- --- Expiration Date _Print the name of the Holder Signature
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