2015, 04-14 Permit App: BLD-2015-0817 Reroofa Community Development Department
00 Permit Center (Staff Use Only)
S061dY OF � 11703 East Sprague Avenue, Suite B-3
we Spokane Valley, WA 99206 PERMIT NUMBER:
�1�� Tel: (509) 688-0036
Fax: (509) 688-0037 PERMIT FEE:
i)ermitcenter@sDOkanevalleV.orQ
COMMERCIAL RESIDENTIAL
SITE ADDRESS: L -LI GV C9��� 760a V4�
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: Ga a�� &
ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTACT NAME: APrA
PHONE: -,Sag - ( 6 5 ' S l FAX: �50 1- 7 { *7 ( d Z o CELL:
CONTRACTOR NAME: Cts x y ^ y xtti
MAILING ADDRESS: 1 2
CITY: O c S O P -C"
PHONE: 45-0 9 ` QC -10- o
O`
-7 (
CONTRACTOR LICENSE Nor.: 1 ,/A111-
e 5 1Aev AUe
STATE' lM�
FAX' VIA --
zip:.
CELL: 1'/4-.
�QwP EXPIRES: tbV ZJ, Z2110CITY BUSINESS LICENSE NO.:
Tear Off Overlay
TOTAL COST OF PROJECT: $ ,
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 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 �Qvti Date: 'q/t
Project #R(D-24(S- l
RECEIVED
APR 14 2015
CSV PERMIT CENTER
Updated 1-11-11 I SUB #
http://www.spokanevaIley.orgVL[estQmgE
1496'/ tmit_1-11-11.doc
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