2008, 08-12 Permit App: 08003128 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
Community Development
Reroof Construction
Permit Application
SITE ADDRESS:
PERMIT NUMBER:
2
PERMIT FEE:
Commercial
Residential
/c2o3 UcAaeit4,7
ASSESSORS PARCEL NO:
Building Owner:
Name: Nth/4,ka.s Log_
Address: 1A Zq 81-4
Name:
Phone: z( fl _ S72' Fax: 2?0 — e(9V5
itpDate:
Contractor Lic No:moife
Address: 10z 03
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wk. we
City: 5a c Ur
State:
Zip: 9j'y
/ 77��
Phone: /7q7- 6128 7
Fax:
Contact Person.
Name: 1704 Ho/044,1
Phone: Z 18 - 5/Z1
Describe the scope of work in detail:
Contractor:
Name: Nth/4,ka.s Log_
Address: 1A Zq 81-4
4. State: J 2 Zip: *20t/
Phone: z( fl _ S72' Fax: 2?0 — e(9V5
itpDate:
Contractor Lic No:moife
City Business Lic. No:
Tear off
Overlay
Cost of pr ect: $
- /00( 4o
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 develo elft ri• is granted by any issued permit inure to the property owner.
Signatur
Method of Payment:
❑ Cash
IIX1 Check
❑ Mastercard
Date
❑ VISA
/z/G 6
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005