2010, 12-11 Permit App: 10004085 Reroof Permit Center
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11703 E Sprague Ave, Suite B-3 PERMIT NUMBER: 6�
• Spokane Spokane Valley,WA 99206
�Valley� PERMIT FEE:
(509)688-0036 FAX:(509)688-0037 `j3--
www.spokanevalley.org
Community Development
Reroof Construction Commercial
Permit Application Residential
SITE ADDRESS: E 1 3 0 I l
ASSESSORS PARCEL NO:
Building Owner: Contractor: , r R
Name: Name:
/"'IQ f/VC/S cc7 / )4,4(#;
Address /_3 go y ( - Address:
City:• bo(6VVE V/-l/E y State: 9s� Zip: f7A Jb City: State: Zip:
Phone:! Fax: Phone: Fax:
5-0 9 g a g o 35'7
Contractor Lic No: Exp Date:
Contact Person City Business Lic.No:
Name:
Phone:
Describe the scope of work in detail: Tear off Overlay
Cost of project: $ /2 7 I
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 any issued permit inure to the property owner.
Signature /,2////i Date
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005
A MacARTHUR Co, PACKING LIST
-6015 E BROADWAY AVE s DATE ORDER#
• SPOKANE VALLEY, WA 99212 TIME 13 : 01 P/L
509 - 535-7477 PH 12/17/2010 35138-01
509 - 536-1668 FAX#
SHIPPED TO PAGE 1
99819-81 SPOKANE CIA/COD'S *# 13804 E 16TH
TAG: 13804 E 16TH
**ALL SALES FINAL-NO RETURNS** MON--12/20--10 : 00
WA . WA
ATTN-
:USTOMER P.O. SLSM PLACED BY SHIPPED VIA PACKED BY DATE PACKED PACKAGING
13804 E 16TH 002 081 *
Hf STK ITEM# DESCRIPTION ORDERED SHIPPED UNIT PRICE AMOUNT
001
M TAG: 13804 E 16TH
002 IK274581 81 BDL 60 60 19. 00 1140 . 00
CAMBRIDGE 30 DRIFTWOOD
30 YR 3 BLDS/SQ
003 IK274290 81 BDL 2 2 25 . 16 50 . 32
MARATHON ULTRA NW D'WOOD
30 YR 3 TAB 3 BLDS/SQ
004 NW204716 81 EA 15 15 2 . 90 43 . 50
G METAL WHITE
005 EA 50 . 00
M DELIVERY CHARGE
V
c/
1\0\100 (I. oel, i
i . tot.
r; 9?Qv , ,
\, It\,t1i \Y/P v
A, N v- 0
BILL TO:
1
1
1
5151. 00 LBS 1283. 82 . 00 . 00 107 . 35 1391 . 17
WAIVER OF RESPONSIBILITY
THE DELIVERY DRIVER HAS DETERMINED THAT A DELIVERY CANNOT BE MADE WITHOUT SOME POTENTIAL DAMAGE TO PROPERTY(I.E.DRIVEWAY,CURBS,LAWN,TREES,ETC).THE PERSON SIGNING THIS
DOCUMENT AUTHORIZES THE DELIVERY DRIVER TO DRIVE ONTO THE PROPERTY DESPITE A WARNING OF POSSIBLE DAMAGE.THE PERSON SIGNING THIS DOCUMENT ASSUMES FULL RESPONSIBILITY FOR
ANY AND ALL DAMAGE TO PROPERTY AND FURTHER RELEASES THE DELIVERY DRIVER AND THE COMPANY OF ANY OBLIGATION AS A RESULT OF OUR VEHICLE ENTERING UPON THE PROPERTY.
DATE Received By
Mac Arthur Co-BR 81
6015 E BROADWAY AVE
SPOKANE VALLEY,WA 99212
MERCHANT#490300042909
Swiped Sale
REF NUM:74 AVS:0
VISA
************5231 EXP.:****
INV NUM:35138
DATE: 12/17/2010 1:06:47 PM
AUTH NO:906736
TOTAL: 1300.00
CUSTOMER ID:
FRANCISCO P TOBIAS
Customer Copy