2005, 09-21 Permit App: 05003478 Tear Off, Reroof SczT�cr ier►► Permit Center ,� 4 `- s = w, `'' -ew=
pokane 11707 E Sprague Ave, Suite 106 e r
2.0000� Talley Spokane Valley,WA 99206
Valley (509)688-0036 FAX:(509)688-0037 �� `�
Community Development www.spokanevalley.org.com.
Reroof Construction ❑ Commercial
Permit Application XResidential
SITE ADDRESS ,/ 3- 01.3 a. C 7 (
ASSESSORS PARCEL NO: LEGAL DESCRIPTION:
Building owner Contractor
it
NamG /7- frif e-'l S Name: t k tA ti V` t, e
Address: g' `j e 517� cJ , Address:
Ci /( q Zip: .�oz! 6- City: Zip:
.
Phone: -(9S7c%Fax: Phone: ?� .j x:
Lic No: Exp.Date:
Contact Persons ..6.; City Business Lic No:
Name:C.- -1 'e....-
Phone: ?cp '.- 0 ?/
Describe the scope of work in detail: 1XTear off ❑ Overlay
Cost of project $2 arc, O "
DISCLAIMER
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 vio - ion o federal, state or local laws, codes or ordinances. 6) Plans or
additional inform. .: : be required to •e submi ed, and subsequently approved before this application can be
processed.
Ownershi• - - ulting development r'. - : - ed by y issued permit inure to the property owner.
Sign:ture _ V_ _ '�/_. ` _. Date ?/: -//e).-5-.
Method of Pay ent: (Faxed •ermit applications will only be accepted with major bankcard)
❑ Cash check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: / Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005