2009, 07-28 Permit App: 09002290 Tear Off, ReroofPermit Center
S°" Ohne 11703 E Sprague Ave, Suite B-3
P l�Q Spokane Valley, WA 99206
A
Valley4000
(509)688-0036 FAX: (509)688-0037
permitcenter • spokanevalley.org
Community Development
Reroof Construction
Permit Application
PERMIT NUMBER: /-aa-�-
PERMIT FEE:
Commercial
Residential
SITE ADDRESS:
G/o S, .fir
ASSESSORS PARCEL NO:
Building Owner: - : - - -- _ _
Contractor:
Name:M:7 `
Name:C'.c
Address: sA0 ��r .._r-
Address: /0,3 S /R,-._sel
City: k_.,G1 „- ~-e— State: Zip:et,
City: s�/�2Q State: &L._ Zip: Ztp.�Z
Phone:Fax:
Phone: 9 zf ns—c, Fax: 9 it
C nt ctor IA45 Exp Date:
Contact Person= - - -_ _=_ --
City Business Lic. No:
Name: \-- c.. \
Phone: at* ZS ---'}mac/
Describe the scope of wor in detail:
__
Tear off
Overlay
Cost of project: $ SoSo
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 develop r .._:,.J _ • ranted by any issued permit inure to the property owner.
Signature
Method of Payment:
❑ Cash ❑ Check 9 Mastercard 9 VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
Date zfs p9
Effective October 28, 2007
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P:\Community Development\Building Division\Jodreomm'I\PCRRcroof Building Permit App.doc