2010, 07-19 Permit App: 10002149 ReroofPermit Center
Spokane 11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
.•••*Valley. (509)688-0036 FAX: (509)688-0037
www.spokanevalley.org
(0 9I 7
Community Development
Reroof Construction
Permit Applicatio
PERMIT NUMBER:
PERMIT FEE:
A
Commercial
Residential
SITE ADDRESS: 6 3„) 2 si-c: vi. C ,se vccvt Ali eJ q `l 3
ASSESSORS PARCEL NO: •,
Building Owner: kC ZR
Kin/Q-4
Name:
Address: 163?Li L
2;ver,Z16
City:
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State:
Zip: `tic 3 7
Phone: soci_Fax:
Fax:
Contact Person
Name: l zA✓
Phone: Se - - S y tsQ
Describe the scope of work in detail:
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Contractor:
Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
Tear off
Overlay
Cost of project: $c &'0
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 WI
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature: Ni<�\�"
REVISED 8/2312005
Date CJ 1 C4