2008, 09-10 Permit App: 08003576 ReroofPermit Center
°Tt'°Fk�,re 11703 E Sprague Ave, Suite B -3
AA1111 Spokane Valley, WA 99206
�Valley� (509)688 -0036 FAX: (509)688 -0037
www.spokanevalley.org
Community Development
Reroof Construction
Permit Application
Commercial
Residential
SITE ADDRESS:
ASSESSORS PARCEL NO:
I (V 48a eet
Building Owner:
ffeiA,11 Name:
e^
(-4,a r
Address: �/ 'to
/k
i- R h ot e,-.1 4 4/
City:
�/I � p yr �
/ , l y State: Llot Zip: 992/6
(/ �7
Pho e:523. g r}Z� �( 79 Fax:
Contact Person
Name:
rvui'd go (4
Phone: 5-g) 9 q �' v(7
Describe the scope of work in detail:
Contractor:
Name: ip triz,h
Address:
City:
State:
Zip:
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
Tear off VI Overlay
61(/-d- /ay c rr`5,kr (
Cost of project: $ a-00
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
Method of ayment:
❑ Cash M Check
Bankcard #:
Authorized Signature:
❑ Mastercard
Expires:
Date 9—'0 O
❑ VISA
VIN#tECEIV ED BY
CITY OF SPOKANE VALLEY
SEP 10 2008
Effective October 28, 2007 BY
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P: \Community Development\Building Division\Jodi- comm'l\PCF\Reroof Building Permit App.doc