2009, 11-02 Permit App 09003551 Re-RoofPermit Center
11703 E Sprague Ave, Suite B-3
�j/ 11LL11G Spokane Valley, WA 99206
,,;ooWW1ey° (509)688-0036 FAX: (509)688-0037
www. Mokanevalley.ore
Community Development
Reroof Construction
Permit
SITE
ASSESSORS PARCEL NO:
9-353/ 3�r
PERMIT NUMBER
PERMIT FEE:
❑ Commercial
❑ Residential
Building Owner:
Contractor:
Name: AYName:
Address:
Address: IQ
City: n
tate: Zip:
City: State: Zip:
Phone
Fax: Phone: Fax:
Contractor Lic No: Exp Date:
Contact Person
City Business Lic. No:
Name:
Phone:
the scopq of work in detail: n .7 , /KTTear off ❑ 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 islwill 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#:
Authorize Signat
REVISED 82