2012, 05-24 Permit App: BLD-2012-0721 Reroofpokane
.000 V 'Hey.
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
perm itcen terPspoka neva l ley. orq
Zdi2- 07L/
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE: 12 9, 7
REROOF CONSTRUCTION PERMIT APPLICATION
�• COMMERCIAL RI RESIDENTIAL
SITE ADDRESS: /008 n%, gess/e
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: ✓/a IL
ADDRESS: /0 o IVa 66 ('C
CITY: S ' o
PHONE:
STATE:
ZIP: 14(i!Z
FAX:
CELL:
CONTACT NAME:
PHONE:
FAX: CELL:
CONTRACTOR NAME: P/Z.oFss/0�1✓YL
442
MAILING ADDRESS:/ 7/3 /
CITY: 140,4-4ge
PHONE: 569- Vg- 33010
FG4'T gpvp Spe-a/'-Gt r
STATE: ' Via ZIP: 992/2
FAX: - CELL:
CONTRACTOR LICENSE NO.: Pi2'PeFiLQ pc d Z EXPIRES: T.20 . l2
CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
7Z -/Y2 0 0
Tear Off
TOTAL COST OF PROJECT: $ , 062
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j Overlay
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 propert .wner In this transaction. 4) Ali -construction is to be done In full compliance with the City of
Spokane Valley Develo ment de. Reference- codes are a allable for review at the City of Spokane Valley Permit Center. 5)- The City of
Spokane Valley p ermi is not permit or appal for any o tion of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be r quired o be submittend subsequ n approved before this application can be processed.
Signature
Date:
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof Permit_1-11-11.doc