2005, 08-30 Permit App: 05003153 Porch Roof RepairtQS3IS3�-
r Permit Center 73.7c
Sr'r' okane 11707 E Sprague Ave, Suite 106
40000Val le Spokane Valley, WA 99206
Y (509)688-0036 FAX: (509)688-0037 ! '
Community Development www.spokanevalley.org.corn
Reroof Construction
Permit Application
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PERMITNUMBER
µPERMIT FEE .`
❑ Commercial
22esidential
SITE ADDRESS 13 D ,� 6LAJciA0 A.
ASSESSORS PARCEL NO:
LEGAL DESCRIPTION:
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' iildmglowner
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Name 00) T) li\.
Address: c54;r C0 e, LiL o
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City4f' k Zip: fV( L 31 b
Phone: 90 3M?2Sl:
ontactlitersonr
Describt the scope of work in detail:
Contractor 'm.AF�'
a' .. ' f , ?1a r
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Name h&Q
Address:
City:
Zip:
Phone:
Fax:
Lic No:
Exp. Date:
City Business Lic No:
71 Tear off ❑ Overlay
,0-c_A Ct r Z Ani - PO -tic
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 rep-esent 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 $ �L,�..c (8 _
Date — 36 —CD S
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
lash
Bankcard #:
Authorized Signature:
REVISED 8232005
❑ Check ❑ Mastercard
❑ VISA ❑ Other
Expires: VIN#: