2009, 07-21 Permit Application: Roof ReplacementAgffi Permit Center
Spokane 11703 E Sprague Ave, Suite B -3 PERMIT NUMBER: Z�
Spokane Valley, WA 99206 PERMIT FEE:
Valley - (509)688 -0036 FAX: (509)688 -0037
www.spokanevalle .or
Community Development
Reroof Construction ❑ ommercial
Permit Application Residential
SITE ADDRESS:
ASSESSORS PARCEL NO:
Building Owner:
Name:
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Address:
13 �t �
City:
Mt e:,
Phone: 5 r,
Fax:
Contact Person
Name:
Phone:
Contractor:
Name: ��
4
Address:. v 1 r
13 �t �
City: /
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Phone: .` 1 G Z Fax:
Contractor Lic No: G
ct
. �� p Date:
City usiness tic. No:
Describe the scope of work in detail: ❑ Tear off Overlay
Cost of project: $ S) C) c) ()
The permitee verifies, acknowledges and agrees by their signature that 1) If this permit is for construction of or on a
dwelling, the dwelling is /will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or
additional information may be required to be submitted, and subsequently approved before this application can be
processed.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Signature Date ,•�`�
Method of Payment:
] Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN #:
Authorized Signature:
REVISED 8/23/2005