2006, 04-06 Permit App: 06001228 ReroofMAY 27 2003 11:37 FR
City of Spokane Valley
`41707 East Sprague Avenue, Suite 106
ipokane Valley, WA 99206
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PERMIT #
BUILDING PERMIT APPLICATION
PHONE (509)688-0036
FAX # (509)688-0037
f 773
Box 1 OWNER 1,._V1 (\(\ 3OX Y\Q,r JOB LOCATION <.35703.-S. •QI(\Q-S
OWNER'S ADDRESS CGict•-t CITY PHONE
DESCRIBE JOB `J Y O0 f
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME5 r« obi\ PHONE h g ?)—I %(4
\
CONTRACTOR'S ADDRESS 9 1 I LE :&1-)c 1.0-1-\\N -t-A-3(0% CITY S?
CONTRACTOR'S REG.# b 1f nx*- O\ 0\:_m EXPIRATION DATE 01
(CARD MUST BE PRESENTED AND COPIE OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT IPDY 0., PHONE C) g - cit%
ADDRESS
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BOX 5 ESTIMATED PROJECT COST $ DO0 EXISTING BLDG. VALUATION $ ---
BOX 5 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
CITY ZIP
—
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR / OTHER /
BASEMENT UNFINISHED / DECK_
1ST FLOOR / 2ND FLOOR /
BASEMENT FINISHED /
/ GARAGE /
CARPORT / TOTAL / 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
IMPERVIOUS SURFACE
SQ. FT.
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 DATE ���p (�co
I hereby authorise the City of Spokane Valley to charge the tenor this penult to my credit card:
Visa Dfsstet'eard --- ---- Expiration Date
Print the name of the Holds Signature.