2009, 10-21 Permit App: 09003411 Reroof Permit Center z
Spokane 11703 E Sprague Ave, Suite B-3 PERMIT NUMBER: `7 I
Valley Spokane Valley,WA 99206 I 1 �S
6 (509)688-0036 FAX: (509)688-0037 PERMIT FEE:
www.spokane valley.org
Community Development
Reroof Construction Commercial
Permit Application Residential
SITE ADDRESS: ieq9 s. S Th L Ey
ASSESSORS PARCEL NO:
Building Owner: Contractor:
LLER
Name: Name: (1US�i��l`iAc W C urr6I(5 ije .
Address: `72 Address: i 2 tivZ e.\..). .►J( u i S i v
City: Spo ? � Vr ,L ,e-1, State: ul.)i1/4_ Zip: qcj City: t�0 jZ e State: Zip:9 4 Z i
Phone: Fax: Phone: �'�``�,1167_vc-lif c) Fax: 5 c, Y6S- q
Contractor Lic No: Exp Date:
Contact Person City Business Lic.No:
Name: AD l- U t C.v{ 1 N S
Phone: Sot - Z i Q>- -7 3
Describe the scope of work in detail: Tear off YOverlay
0F 006 x15771,.5 i or -
Cost of project: $ 5-000 •
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 r: ,Iting development rights granted by any issued permit inure to the property owner.
Signatur: ' f Date [OA/L//47
Method of Payment: 111
❑ Cash ❑ Check ❑ Mastercard [ki VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 6/23/2005