2012, 09-11 Permit Application: BLD-2012-1541 ReroofCommunity Development Department
Permit Center
11703 East Sprague Avenue, Suite 13-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688 -0037
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(Staff Use Only)
PERMIT NUMBER ::
PERMIT FEE: (C- 1 O /x 1` v
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL ❑ RESIDENTIAL
SITE ADDRESS: z4.515//5-- A -d4.4s ad , S � e wi 1(er urn
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ASSESSORS PARCEL NO.: j o ,q3 LEGAL DESCRIPTION: ba/ -,9,5--- /l�= rr�udzd
BUILDING OWNER NAME: x) j -Che,7 J'JlDZ FT Dr E�7Z22
NAME:
ARSE:
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PHONE: io 7 9 — 5 lJ
CONTACT NAME:
STATE: y
ZIP:
FAX: CELL:
PHONE:
FAX: CELL:
CONTRACTOR NAME: 0 N Ak
MAILING ADDRESS:
CITY:
STATE: ZIP:
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DET t L AND INDICATE USE:
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[Tear Off ❑ Overlay
TOTAL COST OF PROJECT: $ j d r—
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 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.
Signature
Method of payment: ❑Cash ❑ Check
Bankcard #:
Date: -1/—/2-
❑ Visa ❑ Mastercard
EXP: VIN #:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
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10.28.07.doc