2013, 04-24 Pemrit App: BLD-2013-0721 ReroofCO6(.4-B-"72.--
-
T'ermiiceu P Project #
11703E Sprague Ave, Suite B-3 IR E C E T r
Spokane Valley, WA 99206
4400110Va ley' (509)688-0036 FAX: (509)688-0037 APR _ PERMIT FEE:
www.spokanevalley.org
Community Development
SpOe
Reroof Construction
Permit Application.
SITE ADDRESS:
CSV PERMIT CENTER
c wi erciai
Residen
SUB #f
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ASSESSORS PARCEL NO:
Building Owner:
Name:AfrfrcL
j 1 iteAddress
State: Zip:
City:
Phone: Fax:
Contact Person
Name: C.o. r j pf i.K-
Phone: ,fes _rPg
Describe ope of work in detail:
(1'18V-9._ kiS 4
S -f- -t 1 lu CeU
Cost of project: S4+G DG
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 focal Paws, 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
1
qcf2o(to
•
Contractor:: •
.
Morris Clark
.
Siding & Roofing
E. Garland
WAS9207
482-2833
Naive: 2728
Spokane,
Address:
City:
State:
Zip:
Phone: $.;,,'-g 1 f:z.
, Fax:6:71
`5t 7
Contractor Lic No: Exp Date:
1,11 E, 1CS042.2-4a
i0 -'I (a
City Business Lic. No:
Tear off ❑ Overlay
c; 11/1-6.-01-e c I -u r` liP a te,
Method of Payment:
Cash Q Check
Bankcard #: REDACTED
Authorized Signature:
REVISED 8/232005
Date
❑ Mastercard fg VISA .
Fxoirec' REDACTED VIN#:
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN GS2014-030.