2010, 03-08 Permit App: 10000613 Tear Off, Reroof F�
Community Development Department
Permit Center (Staff Use Only)
Sot kaA—_ • 11703 East Sprague Avenue, Suite B-3 1 (�(
Spokane Valley, WA 99206 PERMIT NUMBER: `O -v' ,\�
OVley Tel: (509) 688-0036 ,S
al ® Fax: (509) 688-0037 PERMIT FEE:
permitcenterOspoka nevallev.org
REROOF CONSTRUCTION PERMIT APPLICATION
0 COMMERCIAL C RESIDENTIAL
SITE ADDRESS: 72 3 g /1"A/4-• 5 6/0iiv- 114u4 y 99.2/2
ASSESSORS PARCEL NO.:5521#.Avg LEGAL DESCRIPTION:( z,41,✓n//ti9,a £ilfPorCefz2t
BUILDING OWNER NAME:h,,4W,FAC�' f •,)-JyJ/7—/,'
NAM E:Z },re;t/Crr 1.5jyf///7`
ADDRESS: 7223 E //7:".4-1,6- �' /
CITY: Sfie/C 4' 01G�,�y STATE: J.- 1 ZIP:?2/2
PHONE: '-O9 Sire'./ 5-7e g FAX: — CELL: —
CONTACT NAME: . 41/PC i'ic ,e. 0/97/77Y
PHONE: 5D9/8 57Ora FAX: CELL:`—"
CONTRACTOR NAME: p/ Aly,C
/7
MAILING ADDRESS: /77L
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
e,pi '_ •!,/- �+ . mac• 515E771C yt ,-A -' -ce i/ ,tt?Cc1
/7&M-Ai Cp,PA//n/6 .5f:))//Q 5 744
Ej Tear Off Overlay
TOTAL COST OF PROJECT: $ /5' 5 `'=
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 rep -sent the property owner in this transaction. 4) All construction Is to be done in full compliance with the City of
Spokane Valley Developmen- ,de. Referenced codes are available f r review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is n permit or approval for any violation o ederal, state or local laws, codes or ordinances. 6) Plans or additional
information may be requii ito be submitted and subseq ntly appr d before this a ication can be processed.
Signature G� p�I�� y Date: a O &
Method of p. m- t: 0 Cash ❑ Check ❑ Visa 0 Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
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