2009, 07-20 Permit App: 09002161 ReroofPermit Center
Stio„�„eet\itt11703 E Sprague Ave, Suite B-3
�7�J /1Q11 Spokane Valley, WA 99206
Sallev (509)688-0036 FAX: (509)688-0037
J www.spokanevalley.org
Community Development
Reroof Construction
Permit Application
PERMIT NUMBER:
PERMIT FEE: g7_ 75
Commercial
Residential
SITE ADDRESS: g2O( [ `p'Cc(
ASSESSORS PARCEL NO:
Building Owner. `.
, R5 Al
Contractor: -
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Name: �t'I I (' km -z5 YX/ � ({/1
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Name: G \i Ki .�7�r -'7y})ii\Q-1
Address: e- iii,26/ b/ i ( , g» )
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Address: E..74 � R I (.m
City: A� -(C(J 0
tile 1I 9 Zip:
City: d(< )j` tate: j/t. ZiP 7)�
Phone: 7/) t1)95/ Fax:
Phone: ;! i I ) Fax:
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Contractor Lic No: Exp Date:
Contact Person il • _. - . -. -
City Business Lic. No:
Name:
Phone:
Describe the scope of work in detail:
Tear off
Overlay
Cost of project: $ OZ)(rt)
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 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 resultingdeve men hts grantedi�: ny issued permit inure to the property owner.
SignatureDate 7//a.)./a7
Method of Payment:
❑ Cash
Bankcard #:
Authorized Signature:
❑ Check
REVISED 8232005
❑ Mastercard
VISA
Expires: VIN#: