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2003, 06-18 Permit: BD03-636 Reroof :ity of Spokane Valley PHONE (509)688-0036 1707 East Sprague Avenue, Suite 106 FAX # (509)688-0037 Dokane Valley, WA 99206 PERMIT #X3--4 BUILDING PERMIT APPLICATION Box 1 OWNER S t,. , _JOB LOCATION l \L(21-- OWNER'S ADDRESS CITY PHONE DESCRIBE JOB . - >�a� � 'I� THIS PROPERTY IS OWNED BY: SINGLE/ • ' IED I PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME ('($J PHONE CONTRACTOR'S ADDRESS CITY CONTRACTOR'S REG.# EXPIRATION DATE (CARD MUST BE PRESENTED AND COPIED OR VERIFIED) BOX 3 CONTACT PERSON OF PROJECT PHONE ADDRESS CITY ZIP BOX 5 ESTIMATED PROJECT COST$ 647 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. 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 .BOVE PREMISES TO PERFORM TH 0' . OR WHICH THE APPLICATION IS MADE. DWNER/AGEN1`.-7-t— DATE l0 t e-p-.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 goe ti, ibex- k /' 6 .2 6 0 ; ',--- '-yc-