2012, 07-02 Permit App: BLD-2012-1016 Tear Off, Reroof�pol�an�� e
Walley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite 8-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spoka nevallev.orq
etzFeer
D/6
(Staff Use Only)
PERMIT NUMBER: �] �7
PERMIT FEE: { / j7• / 5
REROOF CONSTRUCTION PERMIT APPLICATION
0 COMMERCIAL
55C 3 ISesi �r'�-��`1 n L /C17RESIDENTIAL
SITE ADDRESS: GAe ✓(�f/ /� 9520760��
ASSESSORS PARCEL NO.: ' LEDESCRIPTION'
BUILDING OWNER NAME:
NAME:
ADDRESS:
far Sa amd 1% 24/ KDnphe hive
55.013 Ait
CITr:
PHONE:
Ktke Wife,
STATE:
Gag
ZIP: 990/(
FAX: CELL:
CONTACT NAME:
PHONE:
FAX: CELL:
CONTRACTOR NAME: J. g thnsrritefion e fxcailawon
Lie
MAILING ADDRESS: 3301(/. S ) d✓ ke RV . • /j /9
CITY: /L�7�yyi/'i y 66 Q� /STATE: 09.19 /ZIp: '790 9 /jam)
PHONE: / ✓(17� JV/?55-66 Q v FAX: C.JV7T� o7,J �V-`6690 CELL: / 07 'd9(» wc//
CONTRACTORIILICENSE No.: KC°A),SeL 9;D111 XPIREs: Oy. 014- [3 CITY BUSINESS LICENSE NO.: 1l.Q05210` ieus
DESCRIBE TH COPE O WORK IND TAIL AND INDICATE USE:
«x r P f 044 re. - rea7
Tear Off EJ Overlay
TOTAL COST OF PROJECT: $ 4 000, o O
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.constructlon 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 rere to bepubmitted and subsequently approved before this application can be processed.
Signature
Date: P/T Da -
Updated 1-11-11 Page 1 of 1
http: //www. spoka neva Iley.org/fi lestorage/ 124/938/210/948/ 1496/Reroof_Perm it_1-11-11.doc