2009, 09-04 Permit App: 09002848 ReroofSpokane
_Va11ey
Community Development
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevalley.org
Reroof Construction
Permit Application
SITE ADDRESS:
ASSESSORS PARCEL NO:
PERMIT NUMBER: Z.7571
PERMIT FEE:
Commercial
ViZesidential
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Building Owner:
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Name:
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Name �,
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Address:
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City: ,,
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Zip
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Phone:
n� Fax:
-6/9-
State:l A
Contact Person
Name:
Phone:
Contractor:au/yl/
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Name �,
No
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Address a �t r.
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City: k £ ,D
State:l A
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Phone:?- . !a. .—
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Fax:
ContractortrLic No:
Exp Date:
City Business Lic. No:
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Describe the scop] e of work in detail: , / , h,, Tear of Overlay .Zior � 1A Ek OT Co'v+^ S%Tir)P'\ Ur% Aooi 6 ;C�Ot�CR 'RG�{'1 ctJ.�
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The permitee verifies, acknowledges and agrees by their sfnature that: 1) If this permit is forconstruction of or n
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 f. -ny violation of federal, state or local laws, codes or ordinances. 6) Plans or
additional information may be re• uired • be submitted, and subsequently approved before this application can be
o of project: $
processed.
Ownership of
Signature
suiting devel
ent rig
is granted by any issued permit inure to the property owner.
Date q1L110�
Metho�Payment:
i< Cash
Bankcard #:
Authorized Signature:
REVISED 6123/2005
❑ Check
❑ Mastercard ❑ VISA
Expires: VIN#: