2013, 08-30 Permit App: BLD-2013-1740 Reroofis document originally contained confidential credit card
information which was redacted pursuant to RCW 19.255.010
and the original document destroyed pursuant to SOS DAN
GS2014-030.
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
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(Staff Use Only) 2
PERMIT Nut. BER: 22.-)1,--9nnAnl?� -14 u
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REROOF CONSTRUCTION PERMIT APPLICATION -„-22,-.. _�- - -
RESIDENTIAL Projectv_���j quo
ED COMMERCIAL (
SITE ADDRESS: 8-704
ASSESSORS PARCEL NO•: .
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ION:
BUILDING OWNER NAME: A% fr
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NAME:
ADDRESS:
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PHONE:
FAX:
CELL:
CONTACT NAME:
PHONE:
Fax:
COU.:
CONTRACTOR NAME: 11 J,/62,14,25
MAILING ADDRESS: 0-ef
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PHONE:
1-
1l/ 7 ` eV I - 7'1,63 FAX:
STATE: rt/
-367'29
CELL:
ZIP: 7V17
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CONTRACTOR LICENSE No.: gag00Ryi f 4R4 EXPIRES: 0,01—/y CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE;
t e„ -�-
ear Off Overlay
COST OF PROSECT: $,�
TOTAL
DIJC WMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwellinq, 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. ReFerenCe1 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 requir-. be submitted and subsequently approved before this application can be processed:
Signature / Date: 0(P—;24---ig
Method of payment: 0 Cash
REDACTED ❑Check vlitDACTEDastercard REDACTED
.,� _ vIN#: . _
Bankcard #:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Reroof Construction Permit App
10.28.07.doc