2007, 04-02 Permit App: 07001046 Tear Off, Reroof�,kPermit Center
poane 11707 E Sprague Ave, Suite 106
ValleSpokane Valley, WA 99206
Y (509)688-0036 FAX: (509)688-0037
Community Development vrww.spokanevallev.org.com
Reroof Construction
Permit Application
0 6
PERMIT NUMBS
DERMITFE]
3'.
❑ Commercial
Residential
73 .75
SITE ADDRESS
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ASSESSORS PARCEL NO:
LEGAL DESCRIPTION:
Building,owner.,.: :...._ ..._
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Name: 6///Oe6/tic /i/x7e//ot/
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Address: g- 2S7O2 G//%CBt
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city:/veCx//mam LL24zip: 9902-
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Phone:22_6`/Z.Z % Fax:
Zip:
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Name -
Phone:
Describe the scope of work in detail:
Cost of project
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Contractor
Name: e
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Address:
City:
Zip:
Phone:
Fax:
Lic No:
Exp. Date:
City Business Lic No:
Tear off 0 Overlay
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
propertyowner. 3) The signatory is the property owner or has permission to represent the propertyowner 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 d o
ne ights granted by any issued permit inure to the property owner.
9 �!
Si nature L� `�� Date � —z —o
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ OY
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005