2009, 06-01 Permit App: 09001561 ReroofPermit Center
Spokane ~` 11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
40000 Valley* (509)688-0036 FAX: (509)688-0037
www.spokanevalley.org
Community Development
Reroof Construction
Permit Application
PERMIT NUMBER: /5C
PERMIT FEE: j.
- Z >
Commercial
Residential
SITE ADDRESS:
t 5 .
ASSESSORS PARCEL NO:
Building Owner:
Name: mow 4XT h\ 6,' /40 w.•C0+JL7c- - crx‘t:-t3
Address: Q,o ,30x Licks-
ockSCity:
Name:
Phone: So`. -cic-LS- 05-80 Fax: S -1 - to2--1- bo1�,
Contractcu Lis No: Exp Date:
\Swnr�t ccei3► R'I 12-2.1- oi'
Address: tk`s- a- q7_ _s1
City:S���e v iLLi
State: vvot
Zip: go?
Phone: 501_ '� _31,7.5._
3 �l"1.'�
Fax:
Contact Person
Name: , o5 w -esokna b St -1
Phone: CoriCf-. tiS
Contractor:
Name: mow 4XT h\ 6,' /40 w.•C0+JL7c- - crx‘t:-t3
Address: Q,o ,30x Licks-
ockSCity:
City:
1,31A& L.A.Q State: kivk Zip:
oetros
Phone: So`. -cic-LS- 05-80 Fax: S -1 - to2--1- bo1�,
Contractcu Lis No: Exp Date:
\Swnr�t ccei3► R'I 12-2.1- oi'
City Business Lic. No:
Describe the scope of work in detail: rKTear off Overlay
cars Le.atA„ - *oc w( �� y
NaleANA; v"-1
Cost of project: $ -2 —
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 rights granted by any issued permit inure to the property owner.
Signature j Q_, L J Date
Method of Payment:
❑ Cash Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005