2003, 06-04 Permit: BD-03-258 ReroofCity of Spokane Valley
11707 East Sprague Avenue, Suite 106
Spokane Valley, WA 99206
PERMIT #
BUILDING PERMIT APPLICATION
PHONE (509)688-0036
FAX # (509)688-0037
Box 1 OWNER e 1�1 `c: � JOB LOCATION A61C-'i ,d o'
OWNER'S ADDRESS
CITY.' `'�"PHONE
DESCRIBE JOB
THIS PROPERTY IS OWNED BY: SINGLE MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME f\\-, 'k i PHONE *1-/-0/-;(--(
CONTRACTOR'S ADDRESS
CONTRACTORS REG.#
CITY -cy
qq (-'LL- EXPIRATION DATE 6 13 - ()‘5.
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT k\,rA.A v.cti"Pt'( /? o'C1' PHONE cl (J (7<<S
ADDRESS ICf ' CITY ���"- l� ✓_
ZSh'_�.:i.�i—fig -- -
ZIP 9920
BOX 5 ESTIMATED PROJECT COST $ .39U0 EXISTING BLDG. VALUATION $ . .
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR / OTHER
BASEMENT UNFINISHED /
DECK
CARPORT / TOTAL /
1ST FLOOR /
BASEMENT FINISHED
/ GARAGE /
HEIGHT TO PEAK OF BUILDING
2ND FLOOR
11.45
FT.
BOX 8 ( ) 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 K WLEDGE AND FURTHER THAT 1 AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO PRFOR IIE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER / AGENT
nJ�
DATE t' -a3 •
This document originally contaii
confidential credit card information wl
was redacted pursuant to RCW 19.255.
and the original document destro
b'try 'ant to UK DAN Gc2e1 dr13o
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
REDACTED
Expiration Date
Visa/Mastercard _
Print the name of the Holder VI (Cvl I-�
Signatur