2011, 04-19 Permit App: 11000984 Tear Off, ReroofCommunity Development
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
permitcenter(&,spokanevalley.org
Reroof Construction
Permit Application
/
PERMIT7
NUMBER_
NUMBER--
PERMI
Commercial
PlResidential
SITE ADDRESS:
ASSESSORS PARCEL NO:
Building Owner:
Name: cL
Name:
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City:
State: ....
Address:
/47 «
F.
ax*
Contractor Lic No:
Exp Date:
City:
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C.Nes ...
.......
State:
c--
Zip:
9'1RX.
Phone:
Fax:
Contact Person
Name:
Phone: TC1 • 1 2_
Describe the scope of work in detail:
.•••••" •
Contractor:
Name: cL
Address.
- /0Z8 5—„
i
City:
State: ....
Zip: cAck 1.0 C.
Phone:, i_
F.
ax*
Contractor Lic No:
Exp Date:
City Business Lic. No:
Hear off
Overlay
Cost of project: $ cf-=--
,
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 properly 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 Payment:
1- Cash
Bankcard #:
I— Check
_—
Authorized Signa
fl Mastercard
Date
II] VISA
Expires: VIN#:
ve October 28, 2007
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PACommunity Development \ Building Division\Jodi-comml \PCRIZeroof Building Permit App.doc