2007, 06-06 Permit App: 07002135 Reroof Permit Center
S��TrPERMIT NUMBER: j
pokane 11703E Sprague Ave,Suite B 3
Spokane Valley,WA 99206 PERMIT FEE:
,f Valley (509)688-0036 FAX:(509)688-0037 �G
www.spokanevalley.org
Community Development
Reroof Construction Commercial
Permit Application Residential
SITE ADDRESS: (66 / q
ASSESSORS PARCEL NO:
Building Owner: Contractor:
Name: JC' ` Name:
Address: /'�J (9 6 6--) ` � Address: z (_„./ Pa_C ` ' 7 �
City: t c Ur I State: �4. Zip: l rc�Z0L City: 5�� L�cc_ State: A-_ Zip:/(7/ -2
P ? - — " ( y Fax: Phone: ' f #/-7({) ✓7 663 Fax:
Contractor Lic No: SQc.;v( t ('
Contact Person City Business Lic.No: 4(2-Z1l 33 0 C_S ?
Name:t,) d /1 S
Ph6ii& z i 7 Zoo-7—
Describe
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Describe the scope of work in detail: Tear off 4.Overlay
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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 resiting development rights granted by any issued permit inure to the property owner.
Signature Lt. Date
Method of Payment:
99 Cash ❑ Check 111Mastercard 111VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005