2006, 04-28 Permit App: 06001601 Reroof_ y
'ite Permit Center
Ori[ine 11707 E Sprague Ave, Suite 106
���7 Spokane Valley, WA 99206
e,7 (509)688-0036 FAX: (509)688-0037
Community Development www.spokanevallev.org.com
Reroof Construction
Permit Application
❑ Commercial
nesidential
SITE ADDRESS
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ASSESSORS PARCEL NO:
LEGAL DESCRIPTION:
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Name:
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Address:
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ity:
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hone: f i 3-113r Fax:
Name:
Phone:
Describe the scope of work in detail:
tt ar off ❑ Overlay
Cost of project
•ISCLAIMER
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 developSnent rights gted by any issued permit inure to the property o ner.
Signature
Date
6
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check
Bankcard #:
Mastercard
Expires.
❑ VISA
VIN#:
❑ Other
Authorized Signature:
REVISED 8232005
Name: Air() g®ices /6:60,4-:_,•
Address: la -0 1(1, JA 0_0)
L�` ce,76/
City: sLtr Zip: 7
Phone: 2r— Pig. p Fax:
Lic No: Exp. Date:
City Business Lic No:
tt ar off ❑ Overlay
Cost of project
•ISCLAIMER
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 developSnent rights gted by any issued permit inure to the property o ner.
Signature
Date
6
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check
Bankcard #:
Mastercard
Expires.
❑ VISA
VIN#:
❑ Other
Authorized Signature:
REVISED 8232005