2009, 08-25 Permit App: 09002726 ReroofPermit Center
Spot1�ante 11703 E Sprague Ave, Suite B-3
Q11 Spokane Valley, WA 99206
cossolcvalley` (509)688-0036 FAX: (509)688-0037
J www.spokanevallev.orq
Community Development
Reroof Construction
Permit Application
Commercial
Residential
SITE ADDRESS:
5109 N. Loci) c_
ASSESSORS PARCEL NO:
Building Owner:
HA -12 R I S
Name:
Address:
Slogs ti. to(.((c
City: p4KiC,'-'E ykIi-t.) State: (tog.r Zip:1fv6
Phone: 1/45-
0< g22_3oq -7 Fax:
Contact Person-?:.,'.
Name:
Ma/al5
Phone: T 9S-- 2- 2-S b
Describe the scope of work in detail:
Contractor:
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
n Tear off N. Overlay
Cost of project: $ 2 / u— pati 7-61 y/s
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 resulting develgOment rights granted by any issued permit inure to the property owner.
Signature�f/LC�',
Date
Method of Payment:
2 Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005