2008, 08-06 Permit App: 08003060 ReroofPermit Center
VCITY a 11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
.;00sValley (509)688-0036 FAX: (509)688-0037
www. sp okanevalley. ori
Community Development
Reroof Construction
PERMIT NUMBER:`-'
PERMIT FEE:_
❑ Commercial
Permit Application Residential
SITE ADDRESS: Ci - SO
ASSESSORS PARCEL NO:
Building Owner:
Name:
Address: , a/ iq 3
City: 6 Oet?,41c ✓/ELLE State:lt/i� Zip:
Phone:_ gG) Fax:
Contact Person
Name: , G
Phone: 9 9 / Zq
Describe the scope of work in
Cost of project: $ e• c' ap p Contractor:
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❑ Tear off Overlay
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 resulti development right ranted by any issued permit inure to the property owner.
Signatur Date /0���
Method of Payme
❑ Cash ❑ Check ❑ Mastercard
Bankcard #:
Authorized Signature:
Expires:
VISA
VIN#:
Effective October 28, 2007
Page 1 of 1
PACommunity Development\Porms\Building forms\Reroof Building Permit App.doc
Name:
Address: <J9 Al Y41,q/17—I V1 , D/✓
City: State:,
Zip:9qZ/
Phone: -7 P 3;;-4-- Fax:
PegV
Contracto Lic No: Exp Date:
L /�C09�3 /O
ZZ. /�
City Business Lic. No:
❑ Tear off Overlay
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 resulti development right ranted by any issued permit inure to the property owner.
Signatur Date /0���
Method of Payme
❑ Cash ❑ Check ❑ Mastercard
Bankcard #:
Authorized Signature:
Expires:
VISA
VIN#:
Effective October 28, 2007
Page 1 of 1
PACommunity Development\Porms\Building forms\Reroof Building Permit App.doc