2010, 07-07 Permit App 10002019 Re-RoofCommunity Development
Permit Center
Spokane 11703 E Sprague Ave, Suite B-3
A' Spokane Valley, WA 99206
Valley® (509)688-0036 FAX: (509)688-0037
www. spokanevalley. ora
Reroof Construction
Permit Application
PERMIT NUMBER: \\C�
PERMIT FEE: [ CJ j 7�
X
Commercial
Residential
SITE ADDRESS:
ASSESSORS PARCEL NO:
(f4Z/e, C‘,6yA(/'
Building Owner:
Name: C oiape, e ,,,e.4,14.
1)4
Address: / 403 ,& i ,A D4(
City:.5,b4r4--t% State:
Zip: 99zi,
Phone: 9 7& ? 1 Fax
Contact Person
Name: ki
Phone: 9 S 3
Contractor: --)012K4, 4:2y0O7G //2
Name:✓i::�r D i6. e_
Address:/4 /4 At / fEL7 Ai eo
City: 61 A\ i F-74 LL. 5 State: (AJ4
Zip.
/OZ�
Phone: l 5 3 55 F 3 Fax:
Contractor Lic Ns_72,,z 4/3�te: I ,.
0 t /
City Business Lic. No:
Describe the scope of wo k in detail: Tear off
e r/ > V
Overlay
Cost of project: $
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
Method.. ayment:
❑ Cash
•
❑ Check
❑ Mastercard
Date 7 7' �0
❑ VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005