2009, 05-29 Permit App: 09001524 ReroofSpollane
Walley.
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
p e r m i tc e n to re s o o ka n e v a l l eY. o r4
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL
SITE ADDRESS: P-ri / C • Al awirl
RESIDENTIAL
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
99,E/Z
BUILDING OWNER NAME:
NAME:
do n, a- Let, •ialain- s
ADDRESS:
Cm:
PHONE:
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STATE: A✓ T ZIp: 9,9 2/ 2_
FAX: CELL:
CONTACT NAME: C} oN rt. -1-11_0%..._
PHONE:
FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
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Cm:
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Cm:
STATE: ZIP:
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: Cm BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
0 Tear Off
TOTAL COST OF PROJECT: $ 3 000
00
4
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Overlay
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) If this permit Is for construc0on 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) Ali 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) The 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.
Signature Date:
Method of payment: ❑ Cash
Bankcard #:
Authorized SignaturQ //
❑ Check
tiMasavIde
❑ Visa ❑ Mastercard
EXP: VIN#:
Effective October 28, 2007 Page 1 of 1
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