2012, 04-02 Permit App: BLD-2012-0269 Tear Off, ReroofSpokane
jVa11e3'.
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite 8-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
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(Staff Use Only)
PERMIT NUMBER:
PERMrr FEE: -11 f / 1. 7 5
REROOF CONSTRUCTION PERMIT APPLICATION
E( COMMERCIAL
SITE ADDRESS: c25I (
RESIDENTIAL
ASSESSORS PARCEL NO.:
LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: 0-05in n `. 311 1612fzecn
ADDRESS: 05I \''.) •�►C K, _ _
Cm; 3F0Yanc
PHONE:
STATE: (A. A
zip: g9aia
FAX:
CELL:
CONTACT NAME:
PHONE:
FAX:
CELL:
CONTRACTOR NAME:
MAILING ADDRESS: OLO.u•)._ 1l 1 G'- {Lri n
Crn: S v k, m.n e_
PHONE: 53y- $ 3 I
CONTRACTOR LICENSE No.: S PECI tip
1'
STATE:
Zip:. 9 riol.0d.
FAX 5314-l$y7
CELLI
EXPIRES: ilia -ac a CITY BUSINESS LYCENSE NO.: G Qa_
DESCRIBE THE SCOPE OF WORK IN ' ETAIL AND INDICATE USE:
r -o
Tear Off
TOTAL COST OF PROJECT: $ 2/► 956, °()
p=5.IAWER
The permitted verities, acknowledges and agrees by their signature that: 1) If this permlt Is for construction or on a dwelling, the dwelling IS/will
be served by potable water. 2) ownership of this CIN 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 thls transaction. 4) All construction Is Co 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 nota permit or approval for any violation of federal, state or local Taws, codes or ordinances. 6) Piens or additional
Inforrnaeloh may be req . fired to be submitted and subsequently approved before this application tan be processed.
Overlay
Signature
Method of payment: ❑ Cash
Bankcard #:
Authorized Signatures
❑ Check
litst Visa
EXP:
Date:
❑ Mastercard
A
VIN#:
Effective October 28, 2007 Page 1 of 1
http://www.spokanevalley.org/uploads/Gommunity_Deveiopment/Documents/Forms/Building/Reroof Construction Permit
Received Time Apr, 2. 2012 8:13AM No. 6986 App.1.doc