2004, 08-23 Permit App: BLD-04-07468 Tear Off, Reroof 08/23/04 07:53 FAX 5094685081 **CAPSTONE** fl 001
APR 25 2003 10=31 FR -
TO 4685081 P.01i01
Fly of Spokane Valley PHONE (509)688-0036
FAX # (509)68$-0037
707 East Sprague Avenue, Suite 106 �Speci..ier, �g�,poS�'
Dkane Valley, WA 99206 PERNIZT# QL/' l 41te
BUILDING PERMIT APPLICATION l(S , '7 S—
- - roB LOCATION3 ua 1Z. 11-./e._Box 1 OWNER -61=rfi -Dow(ALL _
OWNER'S ADDRESSS/�I35Eoi £Iz'�rITY * HON`E_- 13 79
4
DESCRIBE JOB /61474 '74-ea-,1"0"1-1- —j 5i t re:roar _ _.___
THIS PROPERTY IS OWNED BY:SINGLE/MARRIED ><C31
PARTNERSHIP CORP. ___ -
BOX 2 CONTRACTO S=M; Tb N E _60416-rgu CaloN GO?T-�i1 C PHONE 46$0911/
CONTRACTORS ADDRESS 0. 201.P.O. 358' cm' NINE #411..E fes! CIA WAX0
CONTRACTORS REG.# eAP3re_e-106 U 5 EXPIRATION DATE 3/11 o 5
(CARD MUST BE PRESENTED AND COPIED OR VE PIED).,r=
-
BOX 3 CONTACT PERSON OF PROJECT /,4 7 6A" PHONE dr‘ 3`�Ba;L
ADDREss 2/177 £ 4 Ocr.S c,TY ,e� r_- ZIP 9'ZD 8'
--,--sas..6& -- _,...0.,0F===....==-==== .. r — —� >e�=
s =
NL
SOX 5 ESTIMATED PROJECT COST S e0 ' STING BLDG.VALUATION$ •• -
BOX 8 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
•
/ 2ND FLOOR /
BOX 7 BUILDING SQUARE FOOTAGE(Existing I proposed) 1ST FLOOR.----
3RD FLOOR / OTHER I BASEMENT FINISHED /
BASEMENT UNFINISHED I DECK / GARAGE I
CARPORT I TOTAL - I r_ HEIGHT TO PEAK OF BUILDING FT.
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO, OF UNITS ) L XISTING STRUCTURE Q
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SSO_ FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE -
VERIFYH THE PEO F Y KNOWLEDGE AND FURTHER THATHAT THE TI
TO TAM AUTHORIZED BY THE OWNER OF THE
;ORRECT TO TON FURNISHED BY ME IS TRUE AND
HE BEST
,BOVE PREMISES TO PE 7.RM THE WO FOR WHICH THE APPLICATION IS MADE.
IWNERIAGENT 1/ �/ DATE fx *4
• • • • ••• . •
[,hereby authorize the City of Spokane Valley to
the fee for this permit to mr credit card:
P
Mastercardion nate 6 O ' %
ein �� --
psintthe name oft the Bolder ../It rrno� sstart�w�-_ !%� -
_-. --:.- - /
Ft- -ut✓ CdNa 7dN ** TOTAL PAGE.01
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010 •
and the original document destroyed ll
pursuant to SOS DAN GS2014-030.
AUG 23 2004 08:57 5094685081 PAGE.01