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
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