2010, 07-26 Permit App: 10002245 Tear Off, Reroofriian
.,Valley.
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 itcentere spoka neva I ley.orq
(Staff Use Only) j
PERMIT NUMBER: Z>\
ZGI ,s
PERMIT FEE: I
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL
SITE ADDRESS: 8/3
ASSESSORS PARCEL NO.:
RESIDENTIAL
S. /3es _S -6)o 14-4^- VQ,/( -c
LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME
ADDRESS:
GA7(e6:----
r4/ 3
r4/3 J. ZjCST
CITY: SC2 a /eaat. 4'/6 /
PHONE:
STATE: ti ZIP:
FAX: CELL:
CONTACT NAME: A4 C—o7 (a_
PHONE: 2co - O 9 r FAX: CELL:
CONTRACTOR NAME:LS&S6eNsTRuc 7/7 !C4 peak co,gS -- ( cr/o/J L
MAILING ADDRESS.I
P.o
Sox 124I1co01
CITY:SPOKANE VALLEY STATE:WA ZIP:9901.6 9 9)/ �I
PHoNE:5O9 - 30 v cog - 9 3 5 4 FAX: "/02 - a o 8 ei CELL:509-230-2789
CONTRACTOR LICENSE No.:LSSCOSS9O1K�]O Z lj EXPIRES:5/20/2012 CITY BUSINESS
LICENSE NO.: M 1 6 /t pp C 9 rX.2 P
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
/LooF 7C/AC, OFF /Le -,=ems,— ./e-✓ .SLf/i✓C LdS
6o3 D /Teti
® Tear Off 0 Overlay
TOTAL COST OF PROJECT: $ S38�.. 2_8
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 Wiley 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
Date:7/21/2010
Method of payment:
Bankcard #:
❑ Cash
0 Check
❑ Visa
EXP:
faMastercard
VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
C:\Users\Mom\Downloads\Reroof Construction Permit App.l.doc