2012, 06-06 Permit App BLD-2012-0828 Re-RoofSpokane
�Valleyx
Community Development
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
permitcenter�a spokanevalley.org
Reroof Construction
Permit Application
PERMIT NUMBER:
PERMIT FEE:
Commercial
Residential
CITE ADDRESS: / 3 7l9 6 3
ASSESSORS PARCEL NO:
Building Owner:
Name:
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Address: t --L-i..tck
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City: S-v\c
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State:.k-.�
Zip: SSz.\c_
Phone:
Fax:
Contact Person
Name: k, 0,
Phone:
Describe the scope of work in detail:
Contractor:
Name:
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Address: icc
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City: SQc:\e„,
State: uj,, Zip:9,tZo6
Phone:
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Fax:
ciZS-5o'cc
Contractor L'c No:
Cl,. �C�L g3��
Exp Date:
City Business Lic. No:
T ear off
Overlay
Cost of project: $ Lf U sT
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 b- submitted, and subsequently approved before this application can be
processed.
Ownership of re utf%n9;,•,, en g granted by any issued permit inure to the property owner.
Metho • of Payme ' :
❑ Cash
Bankcard #:
Authorized Signature:
❑ Check
❑ Mastercard
Expires:
Date
❑ VISA
VIN#:
Effective October 28, 2007
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P:\Community Development\Building DivisionUodi-comm'l\PCF\Reroof Building Permit App.doc