2009, 06-25 Permit App: 09001885 Reroof*Wane
I0valley.
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenterPspokanevalley. ord
REROOF CONSTRUCTION PERMIT APPLICATION
gl COMMERCIAL
SITE ADDRESS: 3oi(o OJ Peri(.
RESIDENTIAL
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: (}t(2 - ,
NAME:
T � i F/irci.F
ADDRESS:
3oi6_ t tf' ed
CITY: 5/7c re STATE: (,..4 -
ZIP:
PHONE:
FAX: CELL:
CONTACT NAME:
PHONE:
FAX: CELL:
376- 7YS'
CONTRACTOR NAME: A( c'FQ464_ 6 NIL-) 1c;c (,A) Sn�
2 ► es S"i t. LtJ
MAILING ADDRESS:
CITY:
PHONE:
/ i6te. / I it—
FAX:
STATE: L)'4 ZIP: 9 i c Cr
17 0 — Y5.
CELL: �
CONTRACTOR LICENSE No.: 4Er N R ri),616, EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
?tom c> ( u -V 10/z(.,�
Tear OffAil
❑ Overlay
TOTAL COST OF PROSECT: $ esu
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction 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) 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 sy1r fitted and subsequently approved before this application can be processed.
Signature
Date:
Method of payment: ❑ Cash ❑ Check
Bankcard #:
❑ Visa
EXP:
❑ Mastercard
VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
http://www.spokanevalley.org/uploads/Community_Development/Documents/Forms/Building/Reroof Construction Permit
App.l.doc