2007, 09-10 Permit App: 07003628 ReroofPermit Center
Son OF -1 a 11703 E Sprague Ave, Suite B-3
Y Spokane Valley, WA 99206
49;00Valley x (509)688-0036 FAX: (509)688-0037
0
www. sp okanevall ey. org
Community Development
Reroof Construction
PERMIT NUMBER:?
PERMIT FEE:
❑ Commercial
Permit Application [Residential
SITE ADDRESS:" -
ASSESSORS PARCEL NO:
Building Owner:
Name:
Address: -
City: - State: �i / Zip
Phone: Fax:
Contact Person
Name: / C
Phone: - s
Describe the scope of work in detail:
Cost of project: $
Contractor:
Name:
Address:
City:
Stater Zip�p�
Phone: _ 3
Fax.
Contractor Lic No:.
Exp Date:
City Business Lic. No:
,
[� Tear off ❑ Overlay
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 a yssued permit inure to the property owner.
Signature
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard
Bankcard #:
Authorized Signature:
REVISED 8123/2005
Expires:
Date "4-, /U D;7
❑ VISA
VIN#: