2005, 11-15 Permit App: 05004318 ReroofSpokane
._,•2; Valley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106 '
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevalley.org.corn
Reroof Construction
Permit Application
SRM
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❑// Commercial
�LResidential
SITE ADDRESS ////1/ 6 4-,
ASSESSORS PARCEL NO:
LEGAL DESCRIPTION:
1111. owner.:
Name: M% a Ftri2S �l
Address: / S- , , rpy,ve
City: 5p7%j'c+MP Ka//7 Zip: 9Q?O.s
Phone: 701Z-562 e/ Fax: r
ontacl
'ersc
Name:
Phone: �Z q' 2 3 _/
Describe the scope of work in detail:
PeAar
Contractors
Name: ALI /C22jli
J
Address:Q.%/ A4 t t% ifive)
City: �/ G, Zip: 75 O5
Phone:cg ,23/ Fax:
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//-/ -0-7 /
Lic No/ -/ Q)''t i5 Exp. Date r -; 7r/
City Business Lic No:
]Tear off
❑ Overlay
Cost of project [j' Cep ,7v
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
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) AN construction is to be done in full compliancel'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 result,. •-velopment rights granted by any issued permit inure to the property owner.
Signature
Date //-1.5-
Method
r /.5 -
Method of Payment: (Faxed permitapplications will only be accepted with major bankcard)
❑ Mastercard ❑ VISA
❑ Cash
Bankcard #:
Authorized Signature
REVISED 8/23/2005
Check
jI_Dires: VIN#:
❑ Other
43.