2003, 07-01 Permit App: BD03-724 Addition ;My of Spokane Valley PHONE (509)688-0036
1707 East Sprague Avenue, Suite 106 FAX # (509)688-0037
)okane Valley, WA 99206
PERMIT # 05-7 Z
BUILDING PERMIT APPLICATION
Box 1 OWNER Videuje ky4./3 JOB LOCATION / 23
OWNER'S ADDRESS Wk.�i{ CITY PHONE �' spy&c
DESCRIBE JOB pC "' PitrZ4 elyyooin,c.
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME f_(//,...:777(',02-dz. PHONE g 5-3 2
CONTRACTOR'S ADDRESS PCS 0 o? ' `v6 CITY I) < I /li,f ?2C>
CONTRACTOR'S REG.# /LL/tv cc'/S a le 9 EXPIRATION DATE /2721 , 7
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT 14 0 41C_ PHONE 5-3 26.7 e
ADDRESS Pa 00 /' ' 'G CITY 7P6,`-e12' 4/i ZIP 1 2 (�"
BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER Q/f d- i45-2T21. 3 2'`l3j
LEGAL DESCRIPTION /
/o t 1.3 lD' A:tele ! .-i ..A7zeacxvG(�z Bt'K 2D p,c;c 76 r- 7 7
BOX 7 BUILDING SQUARE FOOTAGE(Existing/ proposed) 1ST FLOOR 1 2ND FLOOR //er
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING 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.
VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND •
3ORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY.THE OWNER OF THE
\BOVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
- / 03
OWNER/AGENT yawr.,- J/ ` ' DATE 77
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card: ,
Visa Mastercard _ _ __ __ _ Expiration Date
Print the name of the Holder Signature
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REGISTERED AS PROVIDED BY' LAW AS
CONST CONT GENERAL
REGIST, ## EXP. DATE
CCO1 ELLIOCC153R9 12/29/2003
EFFECTIVE DATE 12/29/1985
ELLIOTT CONSTRUCTION, CO,
PO BOX 14406
SPOKANE WA'. 47e4",:e
9924
Signature
Issued by,DEPARTMENT OF LABOR AND INDUSTRIE