2003, 06-09 Permit: BD03-306 Roof City of Spokane Valley PHONE (509)688-0036
11707 East Sprague Avenue, Suite 106 FAX # (509)688-0037
Spokane Valley, WA 99206
PERMIT # 51)03 -30 6
BUILDING PERMIT APPLICATION
Box 1 OWNER JOB LOCATION
OWNER'S ADDRESS CITY PHONE �' Oke ta LA./
DESCRIBE JOB k)Ge6
THIS PROPERTY IS OWNED BY: SINGLEARRIEW � '
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME ic\&t \j\ r ,. PHONE `'J ) .2SY-- )
CONTRACTOR'S ADDRESS \\`32Q & _ .tli� CITYZ.,
CONTRACTOR'S REG.# • \\ C,(,, q)--T�w' EXPIRATION DATE 4 /GI/OS
(CARD MUST BE PRESENTED AND COPIE OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT MA Q%v"CoSrn(T1. PHONE c'-'-).- >S��
ADDRESS k G2 O c • i
CITY c- r2.51.,4-V‘.k= ZIP 9q.20-6
BOX 5 ESTIMATED PROJECT COST$ ICOND EXISTING BLDG. VALUATION $ .. . ._
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
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 ( ) 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 YKNOW DGE AND RTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO P T WORK FO HICH THE APPLICATION IS AD .
OWNER/AGENTT6i( -- DATE 6 !�
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
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