2010, 07-01 Permit App: 10001951 Reroof Permit Center
S�T'okane 11703 E Sprague Ave,Suite B-3 �-- PERMIT NUMBER:
p 1LQ Spokane Valley,WA 99206 ' ( ✓ PERMIT FEE:
4.000 Valley (509)688-0036 FAX:(509)688-0037
www.spokanevalley.org
Community Development
Reroof Construction (mmercial
Permit Application Residential
SITE ADDRESS: I Uq 13 _ Z-64l r U`2_ 1" I-)R l l39b
ASSESSORS PARCEL NO:
Building Owner: Contractor:
Name: Name: (j,irlivt()Uli 1\0 a
Address: E Address:
City: , / , State: , A Zip: ?p9/ City: State: Zip:
Phone: Fax: Phone(301 /'77
_ 0 f 3 Fax:
Contractor Lic No: EQ)jh,�qExp Date:
Contact Person City Business Lic.No:1�11Q 622
y
Name: 01,,„/-1 5 F iv( G1
Phone: (cc`I ) .711-gOI
Describe the scope of workin detail: Tear off erlay
�� ��►� t.t.,42- s - ;. 4 s ;fOvL Lux ���II,, (it( +c,,/ is, In
4 )2A cA (o.Lo tette_t, let L41 hav 36LS 0, a i o Jr,�.
Cost of project: $11��Dc',U
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 Date
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard VISA
Bankcard #: Expires: VIN#:
Authorized Signature:, �
REVISED 8/23/2005 /