2010, 05-12 Permit App: 10001363 Tear Off, Reroof Permit Center
Spokane 11703E Sprague Ave,Suite B-3 PERMIT NUMBER: 1-?-)(0-5Spokane Valley,WA 99206 �S
�,�Va11ey6 (509)688-0036 FAX:(509)688-0037 PERMIT FEE: ��
www.spolcanevalley.org
Community Development
Reroof Construction Commercial
Permit Application Residential
SITE ADDRESS: /'/Y/ c/o-deka/1
ASSESSORS PARCEL N
Building Owner: Contractor:Contractor:
Name: `� 06 n 4444
44 Name:
Address: q7/2 V Ge-ywa Address:
City: , c70,6,
6A ,,� State: Zip:C�a/6 City: State: Zip:
Phone: `'"f Fax: Phone: Fax:
Contractor Lic No: Exp Date:
Contact Person City Business Lic.No:
Name: (rx Ur)xd! '/
Phone: (50'77 4 2Y 2,4'
Describe the s pe oh work in detail: - Tear off n Overlay
Cost of project: $ /g62
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 esu ting development rights granted by any issued permit inure to the property owner.
giti- ‘
1;
Sr/ Date
4k11/
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005
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