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2009, 04-10 Permit App: 09000905 ReroofSpokane .Valley 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: //ovy/ - //6•0 ASSESSORS PARCEL NO: Building Owner: Name: %/%% S;fr....-at,i• Address: /4)( Name: /�/t/ /X14//-/-0, �� City Business Lic. No: &6 S5-75— _ Address: City: State: Zip: Phone: Fax: Contact Person Name: Phone: ni-,6•Le6- Describe the scope of work in detail: PERMIT NUMBER: PERMIT FEE: n Commercial Residential x / 2 c2 Contractor: Name: %/%% S;fr....-at,i• Address: /4)( City: `,�� ,ez State: J, ,,4 Zip: yc*p/ 1�, Phone: 8 v (FIs-,, Fax: 7� _��fc Contractor Lic NG.(J//_.jzzi2fOccs Date: jd f, City Business Lic. No: &6 S5-75— _ Tear off Overlay Cost of project: $ Sgt 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 rightsrant d Signatur Method of Payment: ❑ Cash Bankcard #: Authorized Signature: any issued permit inure to the property owner. Date / �/O —47 ❑ Check ❑ Mastercard ❑ VISA Expires: VIN#: Effective October 28, 2007 Page 1 of 1 P:\Community Development\Forms\Building forms\Reroof Building Permit App.doc