2012, 06-28 Permit App: BLD-2012-1003 ReroofSpok.0"44ft.,
ane
�,,f Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
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REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL ❑■ RESIDENTIAL
SITE ADDRESS: 7219 e 5TH Ave Spokane Valley WA 99212
ASSESSORS PARCEL NO.: 35241.3414 LEGAL DESCRIPTION: EMPIRE HTS 2ND L38-39-401132.
BUILDING OWNER NAME: kristopher Pomeroy
NAME: Kristopher Pomeroy
ADDRESS: 7219 E 5th Ave
CITY: Spokane Valley
PHONE: 509-844-8759
CONTACT NAME: Self
STATE: WA
zip:99212
FAX:
CELL: 509-844-8759
PHONE: 509-844-8759
FAX:
CELL: 509-844-8759
CONTRACTOR NAME: Self
MAILING ADDRESS: 7219E 5th Ave
CITY: Spokane Valley
PHONE: 509-844-8759
CONTRACTOR LICENSE No.:
STATE: WA ZIP: 99212
FAX:
CELL: 509-844-8759
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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❑� Tear Off LI Overlay
TOTAL COST OF PROJECT: $ $1200
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 required to be submitted and subsequently approved before this application can be processed.
Signature
Date:
Method of payment: ❑ Cash
Bankcard #:
Authorized Signature:
❑ Check
❑ Visa
EXP:
❑ Mastercard
VIN#:
Effective October 28, 2007 Page 1 of 1
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10.28.07,doc