2006, 02-27 Permit App: 06000602 Tear Off, ReroofCA") - Lr0 Z
CITY OF SPOKANE VALI FY
BUILDING PERMIT APPLICATION
11707 E. Sprague Ave. Suite 106
Spokane Valley, WA 99206
(509)921-1000 or 688-0036 Fax (509) 688-0037
OWNER JOB LOCATION/c// .S
OWNER'S ADDRESS MS // /e CITY 5/ d/74 , Vc/4.. PHONE
DESCRIBE JOBe;"/)"eGP
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORP
CONTRACTOR: BENNETT ROOFING ADDRESS: 331 STONE
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CONTRACTOR'S REG. # BENNER994MQ EXP. DA'Z'E 07/17/2005
CITY Spokane
STATE WA
ZIP 99207 PHONE: 4831873
CONTACT PERSON LARRY BENNETT'
ADDRESS 3318 N. STONE
CITY SPOKANE
PHONE 939-5191
ZIP 99207
ESTIMATED PROJECT COST$ Q„ 6 EXISTING BLDG. VALUATION $
SINGLE FAMILY
) MULITFAMILY (NO. OF UNITS )
( ) NEW CONSTRUCTION
( ) EXISTING CONSTRUCTION
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMNATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF
THE ABOVE PREMSISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER / AGENT
DATE
I hereby authorized the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard Expiration date:
Print the name of the Holder Signature