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2010, 09-23 Permit App: 10003031 ReroofPermit Center Spokane 11703 E Sprague Ave, Suite B -3 Spokane Valley, WA 99206 Valley (509)688 -0036 FAX: (509)688 -0037 49;000 www. spokanevalley. ors Community Development Reroof Construction PERMIT NUMBER: i PERMIT FEE: ❑ Commercial Permit Application ❑ Residential SITE ADDRESS: /'2 'YoY 4; ` ASSESSORS PARCEL NO: Building Owner: Name: Address: City: State: Zip: Phone: Fax: Contact Person Name: lG �( Phone: Describe the scope of work in detail: Cost of project: $ �7d0 po Contractor: /vi S Name: Address: (,� `? D �% s d City: va State: Zip Phone: -Vbq Fax: Contractor Lic No; /C-a Exp ate: City Business Lic. No: ❑ Tear off 0 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. Ownershi resul g developm ig ranted by any issued permit inure to the property owner. Signatu e - Date Method of Payment; ❑ Cash W Check ❑ Mastercard Bankcard #: Authorized Signature: REVISED 8123/2005 Expires: ❑ VISA VIN #: 4