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2003, 06-09 Permit App: BD 03-287 ReroofCity of Spokane Valley PHONE (509)688-0036 11707 East Sprague Avenue, Suite 106 FAX # (509)688-0037 Spokane Valley, WA 99206 PERMIT # � t)7 Z97 BUILDING PERMIT APPLICATION Box 1 OWNERA-dvew F(Qc4 JOB LOCATION 10815 F (01 �2, OWNER'S ADDRESS .St+.-nE CITY V 'aPHONE_jgctI -66Z0 DESCRIBE JOB is PePi4GP Rco-F'1✓ g 49W THIS PROPERTY IS OWNED BY: SINGLE/MARRIED ro qr ric-d PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME N/,A PHONE �— CONTRACTORS ADDRESS CITY S f OGS CONTRACTOR'S REG.# EXPIRATION DATE (CARD MUST BE PRESENTED AND COPIED OR VERIFIED) BOX3 CONTACT PERSON OF PROJECTA�dre,� FrGcK PHONEM/-O&ZO ADDRESS 10815 E7—, 10_t",4t�e CITY SR3K-lWe u?lteyZIP g6?20G --------------------------------------------- BOX 5 ESTIMATED PROJECT COST $ BOX 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 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 IAGENT�(__4Y� DATE r. Lq &;7 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 � � � �, �7 �'� ��/i �, •�