2003, 05-27 Permit: BD03-504 Tear Off, ReroofCity of Spokane Valley
11707 East Sprague Avenue, Suite 106
Spokane Valley, WA 99206
PERMIT # BOC. -37)4-
BUILDING PERMIT APPLICATION
PHONE (509)688-0036
FAX # (509)688-0037
Box 1 OWNER Qat 6.2o v S JOB LOCATION (/7.Z2 f. /At
OWNER'S ADDRESS // CITYS/1" 4„c4145DHoNE CO7 - fq/—yy/o
DESCRIBE JOB Re Ske/ 2 ,&/ a,a/ Re Lo, 42,7/A Tee
467
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME
PHONE
CITY
CONTRACTOR'S ADDRESS
CONTRACTORS REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT 1at„ e..v c PHONE 59/-77/0
ADDRESS //'7Z2 t /y7q,i2 CITY Spoh„e 14 ZIP ZIP 9y20c
BOX 5 ESTIMATED PROJECT COST $ `%tko. "' EXISTING BLDG. VALUATION $ _
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
7.251
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING FT.
BOX 8 VC) 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.
OWNER / AGENT -reimo-v-eB
--
DATE
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard
— — — — ---- — — — — ----
Print the name of the Holder
Expiration Date
Signature
/00/ /Pct'
57-3o •03