2009, 08-18 Permit App: 09002580 Tear Off, ReroofPermit Center
11703 E Sprague Ave, Suite B-3
p xan Spokane Valley, WA 99206
Valley. (509)688-0036 FAX: (509)688-0037
www.spokanevalley.org
Community Development
Reroof Construction
Permit Application
PERMIT NUMBER:
PERMIT FEE: ) 0 /
Commercial
Residential
SITE ADDRESS: (2Z03 Gam} Q ciao volt ds)(A) r\ ---
ASSESSORS
ASSESSORS PARCEL NO:
Building Owner:
Contractor::-..
Name:
Name: 4,�7n0�TDoi 41tt) 000, 7,o6
Address: 4203 F otr)O
City: 55pok j- F• utzt State: w Zi :p92 -/a
f/�/ I�'�'/ Fax:
Phone:
Address:
City: /jg -t, v/ ,jL State: q Zip: (7� . 7
Phone: 9z�3— /8/eU(b-Fax: Y
Contact Person
Name: c—/i.)
Phone: 92.8— 608
Describe the scope of work in detail:
SaiDe9F---
Contractor Lic_N_0: D p -/
City Business Lic. No:
Tear off n Overlay
Cost of project: $ 3800i oo
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 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 violatioh 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:
❑ Cash ❑ Check
Bankcard #:
Authorized Signature:
REVISED 8232005
❑ Mastercard
Expires:
Date
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VIN#: