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
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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
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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.
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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
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