2012, 05-07 Permit App: BLD-2012-0575 Tear off, ReroofSpokane
.00.001nValleys
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 itcenterCai sooka neva 1lev. orq
(Staff Use Only)
PERMIT NUMBER: 6IG -Zo/z 75—
PERMIT FEE: / 5-3 ? s/X/
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL u / El RESIDENTIAL
SITE ADDRESS: I I ODb �- Ccc iiGla
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: Cuzzetto, Sandy
NAME: 5; CM 017 CAT2....te To
ADDRESS: pooh E, `kfLi(�d
CITY: /N'Q \/ Ally
PHONE:
STATE: w�
ZIP:
FAX: CELL:
CONTACT NAME: Txm row 1kr.c.r
PHONE: LMr- S1-4t/_jZ Fax: CELL:
CONTRACTOR NAME: kit» /+ , k1 -S
I°IDq tJ S1- 4t., -s
MAILING ADDRESS:
CITY: CO* NA,l (S STATE:
ZIP:
LI
PHONE: I- t55- 7U- 2_7(5
FAX: CELL:
CONTRACTOR LICENSE No.: NEWHEHR892Q1
EXPIRES: 11/21/2013
CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
Tear off 2 layers of shingle & reroof
Tear off 2 layers of shingle & reroof
❑ Tear Off
TOTAL COST OF PROJECT: $
7 too
Overlay
AISCLAIMER
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 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
Method of payment: ❑ Cash
Bankcard #:
0 Check
Date: 5 -7— 12
❑ Visa 0 Mastercard
EXP: 11/21/2013 VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development \02 Administration\03 Forms - Official Versions\Permit Center\Reroof Construction Permit App
10.28.07.doc