2010, 10-14 Permit App: 10003369 ReroofPermit Center3 3�C1
11703 E Sprague Ave, Suite B-3 / _
Spokane Spokane Valley, WA 99206 `
Valley. (509)688-0036 FAX: (509)688-0037 IC I ��
www. sp okan e val l ey. org
Community Development
Reroof Construction
Permit Application
SITE ADDRESS: 1 bL(Z 3 G- MGT ✓t
ASSESSORS PARCEL NO:
PERMIT NUMBER:
PERMIT FEE:
Commercial
[Residential
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Building Owner://1��F1, cLi�vi i-1&,-(6 IC
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Name: I�� ([:G�E� i/ rT t(r�7�'� c
Name:
Address: I/yZ.3 £. /,,
City: /LL State 0_ Zipy-74
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Phone: 2'f - .30g) (..j Fax:
City:
Contact Pc son />
Name: /4 cLJrt-/ ilAYSte6C=-4
Phone: Z.1q - 2)b =(
Describe the sqope of work�detail:
tibc• ll ate- - /Z11
Contractor:
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
Tear off
Overlay
Cost of project: $
000
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 development rights granted by any issued permit inure to the property owner.
Signature
Method of Payment:
❑ Cash
Bankcard #:
Authorized Signature:
REVISED 8/23/2005
TZ(Check
❑ Mastercard
Expires:
Date
❑ VISA
VIN#: