2003, Permit: BD03-595 Reroof"d ty of Spokane Valley PHONE (.509)688-0036
1707 East Sprague Avenue, Suite 106 FAX # (509)688-0037
pokane Valley, WA 99206
PERMIT # D 0-S—S-- S"----'
BUILDING PERMIT APPLICATION
Box 1 OWNER F Imet4A, JOB J-OCATION Ja..51)� ,b+hOWNER'S AESS i 6(Vg" CITY "HONE
DESCRIBE JOB ( 'Nes.
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED '3.2_
PARTNERSHIP CORP. i te .(QS
BOX 2 CONTRACTOR'S NAME 4). PPien ni j4 PHONE WLI-6795 4 'cc)
CONTRACTOR'S ADDRESS 2-I ! 1-12001fl CITY
A ,
CONTRACTOR'S REG.# IV W.° q90/1--. EXPIRATION DATE r 13 _O-I
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT AA:0 ferrtiMuj PHONE 9911-G7f.i
ADDRESS -- Gi-W — ZIP -
•
BOX 5 ESTIMATED PROJECT COST$ 194(3(7, ( N EXISTING BLDG. VALUATION $ .. - . -_..
BOX6 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/AGENT DATE `
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Expiration Date
Visa Mastercard — _ -- ---- --
i Signature
Print the name of the Holder
—_ - __ _ _ _ _ _._. __.._ _ ___ - .---
g' a / 9 ice.