2003, 09-05 Permit App: BLD-03-02400 ReroofFROM :BARTON ROOFING FAX NO. :5095354953
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Nty of Spokane Valley
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ILS 5354953 P.0 -i 2
1707 East Sprague Avenue, Suite 106
pokane Valley, WA 99206
PERMIT #
BUILDING PERMIT APPLICATION
PHONE (509)688-0036
FAX # (509)688-0037
C-5 x'-100
Box 1 OWNER C,' J I R F i t; S •
JOB LOCATION �6 3 IU. Li I y J�'e A
OWNER'S ADDRESSCITY PHONE
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DESCRIBE JOB -770 (? Re I1 UO ‘.34;2640 C1)
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME /9 4 ;r) Nr2 c 0 .111 PHONE 3 76 r
CONTRACTOR'S ADDRESS uf- y. 3 1 1.9 NI c •ti CITY 4,004(4 /V
CONTRACTOR'S REG.# ,',ART i? ei< 0 770 0 EXPIRATION DATE C' •C 2 0
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT PHONE
ADDRESS CITY ZIP
_
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BOX 5 ESTIMATED PROJECT COST EXISTING BLDG. VALUATION $ —•
BOX S PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
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BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR I .2ND FLOOR /_ _
3RD FLOOR / OTHER 1 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 1 INDUSTRIAL TOTAL AREA OF PROPERTY SO. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE SQ. F7.
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1 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.
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OWNER /AGENT l r J �JWr
DATE 9 -x -0 3
I hereby authorize the City of Spokane vis to charge the fee for this permit to my cred[t card:
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aMastercat 1�Qi astioa Date
LYrint the name of the Boldo
the
AUG 30 2003 13:05
/J .r4,4_ Signature
document originally contained
,3 .ST"'A Gi 8 confidential credit card information which
was redacted •1�-�2SVbi0
and the original document destroyed
pursuant to 505 DAN G52014-030.
5095354953 PAGE.01