2005, 10-26 Permit App: 05004030 Reroofr Permit Center ayr
S okane 11707 E Sprague Ave, Suite 106
Valle Spokane Valle -0036 WA 99206
(509)
Y (509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.org.conr
Reroof Construction
Permit Application
PERMTT NUMBER:;
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❑ Commercial
kr Residential
SITE ADDRESS 28P 1 65' Datta
ASSESSORS PARCEL NO:
LEGAL DESCRIPTION:
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=Suildin 'owner is-�'��
Name: ConAtb. Yo Inna ir1A-5T-
Address: A. SP/ 3 Rade-4 -RA
City: Seg. ►/tel/e Zip: 792-06
Phone: Fax:
eontact-tPerson
Name: R-0her*"trier
Phone: (SJoq) ifl5-O /4y
Describe the scope of work in detail:
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itCO tFaete .cS, D r"{'h+,F: x.R u.--
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Name: Rol. e -fl- 6 Vire/"-
Address: 11722 C ,Z6 os< gyve_
City: Sipkt,,L Zip: 99106
Phone: Fax:
Lic No: Exp. Date:
City Business Lic No:
❑ Tear off 4' Overlay
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Cost of project
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DISCLAIMER
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
`71' Date /O/2e/eS
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ CaSh ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005