2010, 09-07 Permit App: 10002776 Tear Off, Reroof Community Development Department
Permit Center (Staff Use Only)
CITY OFka�^C\111111111k,
11703 East Sprague Avenue,Suite B-3
Spokane Valley,WA 99206 PERMIT NUMBER:
Valk
) Tel: (509)688-0036
k Fax: (509)688-0037 PERMIT FEE:
permitcenter@sookanevallev.orq
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL , RESIDENTIAL
SITE ADDRESS: l y1//. E`, f�t Cl/ AVE",
ASSESSORS PARCEL NO.:ISW.21W LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: 1441ZQ
ADDRESS: ,)I . cj/' �4 J( ,
CM: c5/ 44C Vi4LLE/ STATE: h A ZIP: q 7P/6
PHONE: co?. 90 •3 a67/ FAX: CELL:
CONTACT NAME: ,4,44 1 t/'� E f7 •
PHONE: 5o 9-868• aa'''3 FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
[c Tear Off o ❑ Overlay
TOTAL COST OF PROJECT: $ d2190 "
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 b submitted and subsequently approved before this application can be processed.
Signature Date: 9 1?4
Method of pay -ent: 0 Cash 0 Check 0 Visa 0 Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
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10.28.07.doc