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2003, 08-19 Permit App: BLD-03-02269 Pole Bldg
City of Spokane Valley PHONE (509)688-0036 FAX # (509)688-0037 11707 East Sprague Avenue, Suite 106 Spokane Valley, WA 99206 PERMIT # BUILDING PERMIT APPLICATION Box 1 OWNER tarry L/iio; w JOB LOCATION Lf?og /,(. /d- OWNER'SADDRESS 4708 0. /,arri.CITY.Spoka. PHONE 27//-7ooy/ - DESCRIBE JOB Po at; - 5 Zo>c THIS PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME itxeal kar 5(ee( 5-4ntt{w-re5 / Z-. PHONE lV • Roo CONTRACTOR'S ADDRESS (421`1 &_ CONTRACTOR'S REG.# (C2/55 QOOCS EXPIRATION DATE - 2-V -o5 (CARD MUST BE PRESENTED AND COPIED OR VERIFIED) BOX 3 CONTACT PERSON (OF PROJECT Pa -A--1 L You_,„ PHONE 9Z/ • / 300 n ADDRESS Y/ 0. BDZc TY CITY 51/0) ' ZIP 9rl2/ BOX 5 ESTIMATED PROJECT COST $ EXISTING BLDG. VALUATION $ BOX 6 PROPERTY TAX ACCOUNT NUMBER 4/5-0 // 6 Sag LEGAL DESCRIPTION BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR / 2ND FLOOR 3RD FLOOR / OTHER / BASEMENT FINISHED / BASEMENT UNFINISHED / CARPORT / TOTAL DECK / GARAGE /2-00 -E / 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 UNDERTHE 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. DATE 8,1/7.© OWNER / AGENT I hereby authorize the City of Spokane ey to char ( the fee for this permit to my credit card: Visa Mastercard Print the name of the Holder Expiration Date Signature 1 A tete-1 Soo'