2010, 09-21 Permit App: 10003009 Tear Off, ReroofPermit Center -I a
00 11703 E Sprague Ave, Suite B-3 PERMIT NUR: - ( /?
Spok�=ane MBSpokane Valley, WA 99206 PERMIT FEE: C:
V[Ll1eV` (509)688-0036 FAX: (509)688-0037
Jwvw.spokanevallev.ore
Community Development
Reroof Construction ❑ Commercial
Permit Application IZResidential
SITEADDRESS: 1300(0 %13,09 I01' -
ASSESSORS PARCEL NO:
Building Owner:
Contractor:
Name: I
l't le,�q I Vni
Name:
Address: . c4 04k Aoc
Address:
City: c State: lNA Zip: 99y
City: State: Zip:
Phone: 5-0 117 11 OS3 Fax.
Phone: Fax
Contractor Lic No: Exp Date:
Contact Person City Business Lic. No:
Name: t,. T✓� i clG
Phone: Soq p S3
Describe the scope of work in detail: X Tear off ❑ Overlay
54, (._.
Cost of project: $ y 50(o. c70
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 resujng development rights granted by any issued permit inure to the property owner.
Signature �� Date a,/21�rO
Method of Payment
❑ Cash
❑ Check
❑
Mastercard
kVISA
Bankcard #:
Expires:
VIN#
Authorized Signature:
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