2007, 03-22 Permit App: 07000902 ReroofSpokane
1 - Valley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: -(509)688=0037
www.spokanevalley.org.com
Reroof Construction
Permit Application
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❑ Commercial
57 Residential
SITE ADDRESS S I D S 6oD:\.€
ASSESSORS PARCEL NO:
LEGAL DESCRIPTION:
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Name: PCUI-r1Ctq.
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City: 4 ji 14;IF 1;deS Zip: 9 Moab
Address: i'S / 0 S t -
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Lic No: C/4PST(C /04J6' Exp. Date:
City: 5(6144'e V i2z
Zip:
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I Phone: 9,9(2 - 903tr
Fax:
Contact-persoi
Name:
Phone: 8yt - /,Sas"
Describe the scope of work in detail:
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Name: 6 5✓ -0,- (eft f',1'14c1:-. vi (,
Address: P. CC . 3( 6-s,
City: 4 ji 14;IF 1;deS Zip: 9 Moab
Phone: =/6$ - 'I yS/ Fax: 4✓(4, - S.--0,
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Lic No: C/4PST(C /04J6' 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 resulti-dpveppment rights granted by any issued permit inure to the property owner.
Signature
Date 3- 2a -07
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard j(► VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005 -