2003, 06-23 Permit: BD03-672 Reroof;ity of Spokane Valley PHONE (.509)688-0036
FAX # (509)688-0037
1707 East Sprague Avenue, Suite 106
Dokane Valley, WA 99206
PERMIT #j�DO3'(G�
BUILDING PERMIT APPLICATION
Box 1 OWNER C o rc ( th h Q JOB LOCATION ( a
OWNER'S ADDRESS CITE"' PHONE
DESCRIBE JOBRP t�
4- r -
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME E C l h` -r O v" -c -c- PHONE 2--2-6 -10 6 `lc�
CONTRACTOR'S ADDRESS � 0 ► %d) C( Y cK CITY�Cr1S
CONTRACTOR'S REG.# fl - Com ` D. U �CI� EXPIRATION DATE 1 ' 2 f5.-
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT E✓_ PHONE
ADDRESS CITY ZIP
BOX 5 ESTIMATED PROJECT COST $ YID ?_ EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR / OTHER
BASEMENT UNFINISHED /
DECK
CARPORT / TOTAL /
1ST FLOOR / 2ND FLOOR
BASEMENT FINISHED /
y.50
/ GARAGE /
HEIGHT TO PEAK OF BUILDING
BOX 8 ( ) SINGLE FAMILY
( .) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY SQ. FT.
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 TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
�---a DATE ' 23 G 3
OWNER / AGENT � ��*,•t
I hereby authorize the City of . okane Vaiiey to charge the fee for this permit to my credit card: ,
Visa Mastercard
Print the name of the Holder
Expiration Date
Signature