2007, 10-15 Permit App: 07004140 Tear Off, Reroof Permit Center
�aII of PERMIT NUMBER: /LIG
po7��ne 11703 E Sprague Ave,Suite B-3
1Ka Spokane Valley,WA 99206 PERMIT FEE: 1 7-S
�Valley� (509)688-0036 FAX: (509)688-0037 / /�
www.spokanevalley.org
Community Development
Reroof Construction Commercial
Permit Application rAl Residential
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SITE ADDRESS: l 7 rc C Xl-$ r
ASSESSORS PARCEL NO:
Building Owner: Contractor: ,j,T g"+
/l ?rcj<Ev�
Name: Th r'. � (/y}�C. Name:
�l i't
Address: PA) Address:
City: e State: VA_ Zip: / G2d., City: State: Zip:
Phone: j� �G ' %� Fax: Phone: Fax:
Contractor Lic No: Exp Date:
Contact Person City Business Lic.No:
Name: 6/14-4,1 i
Phone: L( 71 - 6'0 /
Describe the scope of work in detail: Tear off rxt Overlay
Cost of project: $ t F 6r, I0
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 dev lopme right gr ted by a issued permit inure to the property owner.
f
Signature ,/t Date CA- 2
Method of Payment:
[ Cash
111 Check ❑ Mastercard ❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005