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2009, 06-29 Permit App: 09001926 Reroof Community Development Department Permit Center (Staff Use Only 11703 East Sprague Avenue, Suite B-3 SCI 0 neIB Spokane Valley, WA 99206 PERMIT NUMBER: / Valley Tel: (509) 688-0036 °` G Fax: (509) 688-0037 PERMIT FEE: 1� permitcenter@spokanevalley.orq REROOF CONSTRUCTION PERMIT APPLICATION COMMERCIAL 121. RESIDENTIAL SITE ADDRESS: — it, • A _ „f._. _ Cle3 ASSESSORS PARCEL NO.: • L:r AL D SCRIPTION: BUILDING OWNER NAME: o. x NAME: SAcej.....,01n ADDRESS: ALL© 2. 1k,,7 cam` CITY: 5-rtA_C(kik_ STATE: up ZIP: C Uc' PHONE: -C). l.(31 •L4 p—7 FAX: CELL: CONTACT NAME: PHONE: FAX: CELL: CONTRACTOR NAME: MAILING ADDRESS: OLL7 for CITY: STATE: ZIP: PHONE: FAX: CELL: CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.: DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: • 4 Tear Off Overlay TOTAL COST OF PROJECT: $ 3000 .00 DISCLAIMER The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction 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) 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 o be submitted and subsequently approved before this application can be processed. Signature Date: Zai . Method of payment: ❑ Cash El Check ❑ Visa ❑ Mastercard Bankcard #: EXP: VIN#: Authorized Signature: Effective October 28, 2007 Page 1 of 1 http://www.spokanevalley.org/uploads/Community_Development/Documents/Forms/Building/Reroof Construction Permit App.1.doc