2009, 06-18 Permit App: 09001797 ReroofSpokane ems'
,#Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spoka nevalley.orq
(Staff Use 0 y) Q
PERMIT NUMBER: - /
PERMIT FEE:
REROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL �^ %RESIDENTIAL
SITE ADDRESS: 30 G
09 E. .
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: 14cx&se,
BUILDING OWNER NAME: Doo jia A,`)or>1l\Jic.h
NAME:
ow\ -I -V•ro Cbl
ADDRESS: 3E-11",
CIT':
S ikO fit
PHONE:509"535 -o Lng ,,1 11 I_
CONTACT NAME: L1 I' I U\ or 'NA V I c Dom 1 T'co 1 r' 1
STATE: V \LA.SY 1 1
ZIp: 99 ao a,
FAX: CELL:
PHONE:\L) V 1 _535-04t
CONTRACTOR NAME:
FAX: CELL:
MAILING ADDRESS:
CIT':
STATE: ZIP:
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CIT' BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
c ooS CIte:Eac<hf_ctgarc ge
Tear Off
TOTAL COST OF PROJECT: $ Cj (�P\(Q7C� .DSSO c c)0
DISCLAIMER II
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction 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) The 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.
Overlay
Signature
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rn� r1 ll
Method of payment: Wash ❑ Check ❑ Visa
Bankcard #: EXP:
Date: 901,6 JR iiC) ?
❑ Mastercard
VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
http://www.spokanevalley.org/uploads/Community_Development/Documents/Forms/Building/Reroof Construction Permit
App.l.doc