2003, 06-10 Permit: BD-03-310 ReroofCity of Spokane Valley PHONE (509)688-0036
[1707 East Sprague Avenue, Suite 106
Spokane Valley, WA 99206
PERMIT # T3 D O3 -310
BUILDING PERMIT APPLICATION
FAX # (509)688-0037
ox 1 OWNER Ned d 4 n. /►1, /3a + l JOB LOCATION 9z 2- 5 /f-er..l e/
OWNER'SADDRESSi7 P xi it t-A()PHONE 2 -r- -77 -riyo
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DESCRIBE JOB £� hc.„ 74r
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
3g.
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BOX 2 CONTRACTOR'S NAME PHONE
CONTRACTOR'S ADDRESS CITY
CONTRACTORS REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT PHONE 2- v 7» f
ADDRESS / god
N. f Q (/if CI.
CITY /I,,4- ((i ZIP
3F)--54
BOX 5 ESTIMATED PROJECT COST $ /' 'e' ,
EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR /
BASEMENT UNFINISHED
OTHER /
/ DECK
CARPORT / TOTAL /
1ST FLOOR / 2ND FLOOR /
BASEMENT FINISHED
1 GARAGE /
HEIGHT TO PEAK OF BUILDING
/
FT.
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 PERFO M THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER / AGENT N
Gi
DATE C - /G
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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