2007, 10-18 Permit App: 07004192 Reroof Permit Center
SpOkarie 11703 E Sprague Ave, Suite B-3 PERMIT NUMBER: LI, 2,
111 Spokane Valley,WA 99206 PERMIT FEE: ( Q 1
.00Valley. (509)688-0036 FAX:(509)688-0037
www.spokanevalley.org
Community Development
Reroof Construction n Commercial
Permit Application ndential
SITE ADDRESS: / Z S 2 3 E 4~
ASSESSORS PARCEL NO:
Building Owner: Contractor:
Name: ii ,/ Name: S i e rJ
Address: /Z S 2 c Address:,J. c,
City: ��, It 1/44.y State: �1 Zip: City: r/�l l c� , State: wq Zip: /
Phone: Fax: Phone: Fax:
Contractor Lic No: Exp Date:
Contact Person11' City Business Lic.No:
Name: j/VL`t 1T
Phone: 370— o79 7
Describe the scope R '
fear ork in detail; ar off Overlay
/Re olc of 4
Cost of project: $
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 gr nted by any issued permit inure to the property owner.
Signature Date l6/! / 7
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8123/2005