2009, 06-29 Permit App: 09001916 Reroof A -6 Community Development Department
c�TY Permit Center (Staff Use Only)
Spol�ane 11703 East Sprague Avenue, Suite B-3 R I
Spokane Valley, WA 99206 PERMIT NUMBER:
Valley 4000 .
Tel: (509) 688-0036
Fax: (509) 688-0037 PERMIT FEE:
permitcenter@ spokanevalley.orq
REROOF CONSTRUCTION PERMIT APPLICATION
•
0 COMMERCIAL RESIDENTIAL
SITE ADDRESS: 5 y a 3 4/; jly
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: yl(J /` fr-0 / r `
ADDRESS: d,, /V 03 Caii I e L/ /- / _
CITY: 5 PQ/C.,h[_ M//G/ STATE: W/4 ZIP: 0,2 C
PHONE: FAX: CELL:
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: q0.4 //O//en
MAILING ADDRESS: o, 4/ 1374,-
CITY: 2c / ct /< STA
TE -N ZIP: (
3
y
PHONE: c09 99 5.2Go FAX: CELL:
pill r,y6 9. ' J7.
CONTRACTOR LICENSE NO.: � XPIRES: / -1(./ / CITY BUSINESS LICENSE NO.:
`"
DESIBE TH SCOP •F WORK IN DETAIL AND INDICATE USE:
'A+i./ iJ— ` .,
Tear Off { Overlay
TOTAL COST OF PROJECT: $ )0, ,560
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 i not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be req ed to be submitted -•d subsequently approved before this application can be processed.
Signature if `Date: LJ
Method of payment: ❑ Cash ❑ Check 0 Visa ❑ Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
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App.l.doc