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2003, 05-29 Permit App: BD-03-538 Roof.ity of Spokane Valley .1707 East Sprague Avenue, Suite 106 ;pokane Valley, WA 99206 PERMIT # BUILDING PERMIT APPLICATION PHONE (509)688-0036 FAX # (509)688-0037 Box 1 OWNER arleYda mohrp JOB LOCATION /53C)? E m'5S/0y1 OWNERS A DRESS )5W4 E. rn4s g tY krarlQ)e'HONE_ ay 9ay- 3ayy DESCRIBE JOB 6}-bt;3 j e ro0Q THIS PROPERTY IS OWNED BY• . IN / ARRIED PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME 0 L Yfl ? y PHONE CONTRACTOR'S ADDRESS CITY CONTRACTORS REG.# EXPIRATION DATE (CARD MUST BE PRESENTED AND COPIED OR VERIFIED) BOX 3 CONTACT PERSON OF PROJECT ©u � PHONE (92� -3 4 . ADDRESS CITY ZIP Ne Z2= BOX 5 ESTIMATED PROJECT COST $ `7,50°° EXISTING BLDG. VALUATION $ Sc). 460 .---.-. BOX 6 PROPERTY TAX ACCOUNT NUMBER -/z-/ 4/. (:)2.0(a LEGAL DESCRIPTION -e trttAck_i,e erA r -4( z 37 D . . 5a BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR / 2ND FLOOR (.0f 3RD FLOOR / OTHER / 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 / INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT. ( ) TENANT IMPROVEMENT 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 la_k_QQA in'tykiko DATE �_ �-0 3 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 l rJ /66., eel' w7T v�Ot- /7a l / ,..5= 0 - 3 %__. 6-/7-0 3