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2009, 07-02 Permit App: 09001961 ReroofSpokane galley Community Development Department Permit Center 11703 East Sprague Avenue, Suite B -3 \ Spokane Valley, WA 99206 Tel: (509) 688 -0036 \C\ Fax: (509) 688-0037 / permitcenter(a sookanevalley.orq �O REROOF CONSTRUCTION PERMIT APPLICATION COMMERCIAL /,/ /(.. RESIDENTIAL SITE ADDRESS: % /��� 5 z ASSESSORS PA CE 2 ff LEGAL DESCRIPTION: a�� BUILDING OWNER NAME: NAME: Ter ry ADDRESS: / 7 CITY: 'j ID `Ttt(.p C I* I< f K, gyp" u quc�c -�v STATE: 1:--U ZIP: PHONE: 2 2_O (D ?) '3 CP FAX: CELL: CONTACT NAME: ave. C (^f PHONE: CONTRACTOR NAME: FAX: L e CELL: 6'09.939- S;_ s?(6-) MAILING ADDRESS: `Z © 2/ ( /h - Fe ) c CITY: Azi Q i" L �.( L STATE: ZIP: 5 9 Q Z2 PHONE: Sc) 9 2 `3 f -) / z/ FAX: Sa S 'L'7 `/ 40 (0 1 CELL: c o ' i l r7 O,' 3 7 CONTRACTOR LICENSE NO.: L ( J � M E nr / � b EXPIRES: / - 3/, / o CITY BUSINESS LICENSE NO.: DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: ❑ Tear Off Overlay TOTAL COST OF PROJECT: $ 110 p tj DISCLAIMER The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction 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) The 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. Signature --1 Yv Date: 7 Method of payment: ❑ Cash ❑ Check ErVisa ❑ Mastercard Bankcard #: EXP: VIN #: Authorized Signature: Effective October 28, 2007 Page 1 of 1 http: / /www.spokanevalley.org /uploads /Community_Development / Documents /Forms /Building /Reroof Construction Permit App.1.doc