2008, 08-04 Permit App: 08003022 Tear off, Reroof ,'A Permit Center
Spokane 11703 E Sprague Ave, Suite B-3 PERMIT 1:ER:
Spokane Valley,WA 99206
Valley
(509)688-0036 (509)688-0037
PERMIT F`
509 688-0036 FAX:
www.spokanevallev.org
Community Development
Reroof Construction Commercial
Permit Application Residential
s: 4//.: 0/- C ��J4z,j
ASSESSORS PARCEL NO:
Building Owner: Contractor: ,� /9
Name: „/Clue-1/7 A0e ! ,L 71 �2 G� Name. /'�// T
Address: ,"7Z0 t j� 1/41/6, Address:
City:��2) , Imo,[J4/g State: Zip: City: State: Zip:
Phone: GY1 > /`'C v / Fax: Phone: Fax:
Contractor Lic No: Exp Date:
Contact Person City Business Lic.No:
Name: kiike 11/1 Aec ,.eci
Phone: 7'R/— -y-cop'
Describe the scope of work in detail: jg Tear off Overlay
Cost of project: $A)60
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 development rights granted by any issued permit inure to the property owner.
Zustseture
/ y;4
1 , fp Date
Method of Payment:
❑ Cash Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005
Sc n a PERMIT CENTER
pokane 11703 E. Sprague Ave.,Suite B-3
Walley Spokane Valley,WA 99206
509-688-0036;Fax 509-688-0037
www.spokanevalley.org
Affidavit in Lieu of General Contractor Registration
State of Washington )
County of Spokane )
I, / "Cl c_Gjd , state as follows:
(Print name as signed)
1. I have made application for a building permit from the City of Spokane Valley,Washington.
2. I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under RCW 18.27.090,a copy of
which is printed on the reverse side of this affidavit.
3. I understand that prior to issuance of a building permit for work that is to be done by any contractor,
the City of Spokane Valley must verify either that the contractor is registered by the State of
Washington, or that one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Spokane Valley of my compliance with this requirement,I
hereby attest that after reading the exemptions from the registration requirement of RCW 18.27.090,I
consider the work authorized under this building permit to be exempt under No. 6 , and will
therefore,not be performed by a registered contractor.
I understand that I may be waiving certain rights that I might otherwise have under state law in any
decision to engage an unregistered contractor to perform construction work.
APPLICANT'S NATURE
Signed and sworn to before me this
Day of AU(6,20
••‘\""t111 X11
ofER 4;4// 1ck
j 52.�(11� � L �u�i k�
f�',9L Notary's Name(Print)
f ItP 44 lb
i -• _
5 N S N3 . s Signature
i 9�`�`�i,.009_i'1 O - NOTARY PUBLIC in an. for the State of
////OP WASV04 Washington,residing at to & t - ounty
'.tilt%%%\\\\%`'` iv
Commission expires:
October 15,2007 Page 1 of 2 P:\Community Development\Forms\Building Forms
Revised Code of Washington
18.27.090 Exemptions. The registration provisions of this chapter do not apply to:
1) An authorized representative of the United States 11) An owner who contracts for a project with a registered
government, the state of Washington, or any contractor,except that this exemption shall not deprive
incorporated city, town, county, township, irrigation the owner of the protections of this chapter against
district, reclamation district, or other municipal or registered and unregistered contractors.The exemption
political corporation or subdivision of this state; prescribed in this subsection does not apply to a person
2) Officers of a court when they are acting within the scope who performs the activities of a contractor for the
of their office; purpose of leasing or selling improved property he or
3) Public utilities operating under the regulations of the she has owned for less than twelve months;
utilities and transportation commission in construction, 12) Any person working on his or her own property,whether
maintenance, or development work incidental to their occupied by him or her or not,and any person working
own business; on his or her personal residence,whether owned by him
4) Any construction,repair,or operation incidental to the or her or not but this exemption shall not apply to any
discovering or producing of petroleum or gas,or the person otherwise covered by this chapter who constructs
drilling,testing,abandoning,or other operation of any an improvement on his or her own property with the
petroleum or gas well or any surface or underground intention and for the purpose of selling the improved
mine or mineral deposit when performed by an owner property;
or lessee; 13) Owners of commercial properties who use their own
5) The sale or installation of any finished products, employees to do maintenance, repair, and alteration
materials,or articles of merchandise that are not actually work in or upon their own properties;
fabricated into and do not become a permanent fixed 14) A licensed architect or civil or professional engineer
part of a structure; acting solely in his or her professional capacity, an
6) Any construction,alteration,improvement,or repair of electrician licensed under the laws of the state of
personal property performed by the registered or legal Washington,or a plumber licensed under the laws of the
owner,or by a mobile/manufactured home retail dealer state of Washington or licensed by a political
or manufacturer licensed under chapter 46.70 RCW who subdivision of the state of Washington while operating
shall warranty service and repairs under chapter 46.70 within the boundaries of such political subdivision.The
RCW; exemption provided in this subsection is applicable only
7) Any construction, alteration, improvement, or repair when the licensee is operating within the scope of his or
carried on within the limits and boundaries of any site or her license;
reservation under the legal jurisdiction of the federal 15) Any person who engages in the activities herein
government; regulated as an employee of a registered contractor with
8) Any person who only furnished materials,supplies, or wages as his or her sole compensation or as an employee
equipment without fabricating them into,or consuming with wages as his or her sole compensation;
them in the performance of,the work of the contractor; 16) Contractors on highway projects who have been
9) Any work or operation on one undertaking or project by prequalified as required by RCW 47.28.070, with the
one or more contracts, the aggregate contract price of department of transportation to perform highway
which for labor and materials and all other items is less construction,reconstruction,or maintenance work;
than five hundred dollars,such work or operations being 17) A mobile/manufactured home dealer or manufacturer
considered as of a casual, minor, or inconsequential who subcontracts the installation,set-up,or repair work
nature.The exemption prescribed in this subsection does to actively registered contractors.This exemption only
not apply in any instance wherein the work or applies to the installation, set-up, or repair of the
construction is only a part of a larger or major operation, mobile/manufactured homes that were manufactured or
whether undertaken by the same or a different sold by the mobile/manufactured home dealer or
contractor, or in which a division of the operation is manufacturer;
made into contracts of amounts less than five hundred 18) An entity who holds a valid electrical contractor's
dollars for the purpose of evasion of this chapter or license under chapter 19.28 RCW that employs a
otherwise.The exemption prescribed in this subsection certified journeyman electrician, a certified residential
does not apply to a person who advertises or puts out specialty electrician)qq ppatifeloctrjcal trainee meeting the
any sign or card or other device which might indicate to requirements ifttch tat, 8 RCW to perform
the public that he or she is a contractor,or that he or she plumbing work Q►i ,, ' ;' ally, directly, and
is qualified to engage in the business of contractor; immediately :iiiktpriv 4-kind replacement
10) Any construction or operation incidental to the of a housFh t1,. .1, !Air r small household
construction and repair of irrigation and drainage ditches utilization equi i+' t that requires lgnitedelectric power
of regularly constituted irrigation districts or reclamation and limited waste a8d/oViowateonnections. An
districts;or to farming,dairying,agriculture,viticulture, electrical trainee`must 114 dLl iervl. d by a certified
horticulture,or stock or poultry raising,or to clearing or electrician while P€o g phtr ling work.
other work upon land in rural districts for fire prevention `_'+��, x
purposes; except when any of the above work is
performed by a registered contractor;
October 15,2007 Page 2 of 2 P:\Community Development\Forms\Building Forms