2012, 08-15 Permit App: BLD-2012-1319 Tear Off, Reroof. Pennit Center
ggikarr..,n___ 117" tguleey:Ae'992S1613-3
40000 viumq.
(509)6880036 'PAM (509)688-0037
www.spokanevallev.org
Community Development
Reroof Construction
Permit Application
SITE ADDRESS: I 2_0 .
ASSESSORS PARCEL NO:
Bathing Ckaiter -
Name:
Address: (20
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tDoiLLstatei tA-Vt .°A2ia
Ph' 99
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Namc: cs,,v• ‘C -
Phone: c2k it, - I :rceit.
Describe the scope of wolk in detail:
7/0 siie\ ,51.1.4`
PERMIT NUMBER:
PERMIT FEE:
11 Commercial
iSt Residential
Contractor
Name: i-1-,exy-N:i R.,,r- Orc-kYrv-i-nv-c-,
Address: ckCiOS tj - C Q( -\c-\
Catulsts'e:( 3 7AP:9c7jg
Phone: WI - (9 lb *.-10 SZIO Fax:
5Z)9 - 2•S--21 1161-z,
Contractor Lic No:
rritc*-ENRa'- i/a/0013
Cit. y Business Lic. No:
Tear offEI Overlay
QC 0 I(:)orc,ii(t/
Cost of project: $
The permitee verifies, acknowledges and agrees by their signature that 1) Ifthis permit is for constructien of 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 MI compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or (=finances. 6) Plans or
additional information may be required to be submitted, and subsequently approved before this application can be
processed.
Ownership of , - , . granted by any issued permit inure to the property owner.
Signature
Method of merit:
0 Cash 0 Check
Bankcard #:
Authorized Signature:
REVISED 62312005
Date
o Mastercard 0 VISA
Expires: VINS: