2003, 05-30 Permit: BD03-543 Pole Bldg City- of Spokane Valley PHONE (.509)688-0036
11707 East Sprague Avenue, Suite 106 FAX # (509)688-0037
Spokane Valley, WA 99206
PERMIT # 80 O3-51/
BUILDING PERMIT APPLICATION
Box 1 OWNER FF WAY JOB LOCATION loll ! E . �6
OWNER'S ADDRESS ILI2bc CITY Uei-. ek 'PHONE %'Z/-rv�Z V
DESCRIBE JOB Pale &..(, �, — ��� c�z, ,gypx
I .
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED X.
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME i•lou S � S�r•« d �5 $ PHONE 1Z/ • i3v0
CONTRACTOR'S ADDRESS Z I (( CITY
CONTRACTOR'S REG.#E 1 L5$ 60008 EXPIRATION DATE -Z 1-(—O 5—
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT Pa-L-1 Ya v- PHONE 9Z/ • / 3 OD
ADDRESS 14-2_ l'-} CITY J-0-4-�..dLc_Ce ZIP n 5
BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER 4S2.' /. 1 7
LEGAL DESCRIPTION
L/L4 ..r.try-ocG- rce L d
BOX BUILDI SQUARE FOOTAGE(Existin /proposed) 1ST FLOOR / 2ND FLOOR
3RD FLOOR / OTHER / BASEMENT FINISHED
BASEMENT UNFINISHED / DECK / GARAGE ! /65
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING IV. 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.
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 • PER ORM TH ORK FOR WHICH THE APPLICATION IS MADE.
a t,
OWNER/AGEN % ., DATE
So 3 „
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card: , - k 5''
q2
•
Visa Mastercard —2 ` 7 /-5Expiration Date
Print the name of the Holder •� ' ature
3 •
u)
ci,
a � o
6�, Q
1
A
ExisTiN�
-443
Hous."
A
35
fm
kA
APPROVED BY,---241ti
1 -2.�J 6\
Lot (� L
SIZE
,s' e /1 c a- /e".5 A
4... ,
/*C"O ift' ..S 4-
V6," _,2 0- o3
rce,,,, /4 6- ._,2_ - 03 X- v7,frt _
V il *()C1c4 A