2016, 05-21 Permit App: 10001465 Re-RoofPermit Centeri
SCln QFJ 11703 E Sprague Ave, Suite B-3 PERMIT NUMBER: �
Spokane Valley, WA 99206 PERMIT FEE: ICZ�- —
Valley' (509)688-0036 FAX: (509)688-0037
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www. spokanevali ey. org
Community Development
Reroof Construction ❑ Commercial
Permit Application E Residential
SITE ADDRESS: t I LA O -j f _-�- 4-L' P� v q - S P 0 K kv% ( \/ a (f oll � � 10 -Lo ('
ASSESSORS PARCEL NO:
Building Owner:
Name: NQ P
P h' U 14
Address:
City: 57P 0
V a (e State: W4J Zip: 19
Phone: O� Fi)
, 5-� Fax:
Contact Person
Name: R 0 y,,1
Phone: &
O q
Contractor:
Name: '
Address:
City: State: Zip:
Phone: Fax:
Contractor Lic No: Exp Date:
City Business Lic. No:
Describe the sco e of work in detail: Tear off ❑ Overlay
_Tea V- a `� G J e,4 o It V1 sCC (( In L, w i/'0 a
Cost of project: $ 3 100
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
elopment rights granted by any issued permit inure to the property owner.
Signature GA, a,, Date ��- ( ''�Q i6
Method of Payment:
❑ Cash ❑ Check
Bankcard #:
Authorized Signature:
REVISED 8/232005
❑ Mastercard
Expires:
(VISA
VIN#: