2006, 08-18 Permit App: 06003259 Reroofp rkarie Permit Center
11707 E SpragueAve, Site 106
00000 Valley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development aww'.spokanevallev.ore.com
Reroof Construction
Permit Application
PERNII T -NUMBER F
&'PERMIT --FI
❑ Commercial
❑ Residential
SITE ADDRESS.
ttgoe 13e5.71 Ko[ Spotcane Va[ley WA 9q02/6
ASSESSORS PARCEL NO:
LEGAL DESCRIPTION:
}Buildm 'owner . '.." °L
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Name -
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Address:
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City:
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Phone:
Fax:
Address: 6 I
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City Business Lic No:
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Name:
Phone:
Describe the scope of work in detail:
Contractor =
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Name -
Address:
City:
Zip:
Phone:
Fax:
Lic No:
Exp. Date:
City Business Lic No:
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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 Date Of/1,06-
Method
(p.06-
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8232005