2009, 03-25 Permit App: 09000729 Tear Off, ReroofSpokane
•�Valley.
Community Development
Permit Center
11703 E Sprague Ave, Suite B -3
Spokane Valley, WA 99206
(509)688 -0036 FAX: (509)688 -0037
permitcenter Aspokanevalley.org
Reroof Construction
Permit Application
PERMIT NUMBER:
PERMIT FEE:
Commercial
,,Residential
SITE ADDRESS: (4-1-. .pDk Uk)0 Q-NU 1 u_)J Q Q C
ASSESSORS PARCEL NO:
Building Owner:
c�
Name: 11-At KL 4-.�ul 0 I i l e 1-tU t c�
Address:I t 1 L Acs
Citxs ,A 0,, (J vu may. State:
Zip.0
Phone y 4 d ,Zjo S aFax:
Contact Person
Name:./ k) t (1 U() (
Phone: 0 (1 —C-?o� S(— go 1-
Describe the scope of work in detail:
Cost of project: $ 41`.
Contractor:
Name:
Address:
City:
State:
- - --
Zip:
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
off
Overlay
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.
Signatu
Method of Payment:
❑ Cash
Bankcard #:
Authorized Signature:
:heck
Date
❑ Mastercard ❑ VISA
Expires: VIN #:
Effective October 28, 2007
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P: \Community Development\Building Division \odi- comm'I\PCF\Reroof Building Permit App.doc