2010, 07-09 Permit App 10002042 Re-RoofCommunity Development Department
Permit Curter
aTr 11703 East Sprague Avenue, Suite B-3
ne Spokane Valley, WA 99206
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Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spoka neva Iley. orq
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REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL Iq RESIDENTIAL
SITE ADDRESS: 775-1C' E,. -c t CA 0.V , c-'--) pc 1V -O Y\ � e , 1A) A 992-0,
ASSESSORS PARCEL NO.: L�,LVQ*EGAL DESCRIPTION:,,gCV�A ave- add. L57. SFT
BUILDING OWNER NAME:
; E3pFi L3 3t3o
NAME: (! ��/lJ� i� l� I LCC 1 li v f' 1
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL'
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DES IBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
2 P�nlar� Apr k'y\c,--,�lnsnqle.S j t)nde r_%t�e r�P vc
Tear Off ❑ Overlay
TOTAL COST OF PROJECT: S c .e
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction 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) The City of
Spokane Valley permit is not a permit or approval for any violation of federa,4 state or local laws, codes or ordinances. 6) Plans or additional
information may be required be ubmitted and sub quently approved b o e this application can be processed.
Signature Date: ho
Method of payment: ❑ Cash ❑ Check ❑ Visa ❑ Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
http://www.spokanevalley.org/uploads/Community_Development/Documents/Forms/Building/Reroof Construction Permit
App.l.doc