2009, 08-31 Permit App: 09002778 Reroof + Permit Center
San" 11703 E Sprague Ave,Suite B-3 PERMIT NUMBER: —2 7 7 ,
pokane Spokane Valley,WA 99206 PERMIT FEE: 1' � „L
,Valley. (509)688-0036 FAX: (509)688-0037 ,
www.spokanevalley.org
Community Development
Reroof Construction Commercial
Permit Application Residential
SITE ADDRESS: 1 ( 1 t t t ''
ASSESSORS PARCEL NO: _
5 /3 . 077
Building Owner:
Name: I< 0 ,.4. Name:
Address: ' l d„.0 tk, e ‘k Address:
City: s�v � State: ( 9 Zip:C City: _tate: Zip:
Phone: Fax: Phone: Fax:
Contractor Lic Exp Date:
Contact Person City Bus' - s Lic.No:
Name: K 'n - „, )
Phone: Jt 0 7 .6'"
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The permitee verifies, ac nowledges and agrees by their signature that: (1) If this permit is for conhtruction 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. ,A-Dil t5 0 'G�(S pelt 'u i- q C od P-el 4 0 ye ,c,.
Ownership o e ulting development rights granted N any issued permit inure lo the property owner.
Signature t C '4511--k. Date gl 'i U7
Method of Payment:
Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8!23/2005