2009, 04-24 Permit App 09001079 Re-RoofPermit Center
*Wane 11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
�Valleya (509)688-0036 FAX: (509)688-0037
permitcenteraspokaneval ley. org
Community Development
Reroof Construction
Permit Application
SITE ADDRESS: / Z`// S ‘f ' T 7 —(
ASSESSORS PARCEL NO:
PERMIT NUMBER: I 9
PERMIT FEE:'1 ((S--- 7S
Commercial
residential
Building Owner:
Name: `!f�, ,- 7-r&
..
-,-2 -,e
Address j2_,,z7<. --
4
77t
City: C)4..e.. .-
State: f� /
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Zip:
Phon_i
-
Fax
Contact
Name:
son
4i1L- /1(C7/0,
Phone: "7/ D - � c)
Contractor:
Name: ,4 / C i_z-,e /Z
Address:Z7 z � i
City: `�,� StateAu
Zip: rj- `pzo-
Phone-i/s es Fax: l j:72_
��6
Co ctor Lic No: Exp Date:
// �� 5c'
City Business Lic. No:
ear 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 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 informati• • a be required to be submitted, and subsequently approved before this application can be
processed.
Ownership o esultinR .ev�elopment rights granted by any issued permit inure to the property owner.
e
Method of Payment:
111 Cash
Bankcard #:
Authorized Signature:
❑ Check
❑ Mastercard
Expires:
Date
❑ VISA
VIN#:
Effective October 28, 2007
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P:\Community Development\Building DivisionUodi-comm'1\PCF\Reroof Building Permit App.doc