2013, 06-03 Permit App: BLD-2013-1016 Tear Off, ReroofSpokane
*Valley'
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 itcenter(tsooka nevallev.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
REROOF CONSTRUCTION PERMIT APPLICATION
® COMMERCIAL \ Ai RESIDENTIAL
SITE ADDRESS: -2103 d Act_ Poo////����
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: (1 Lai G/N&t6i2r
NAME: • 642/JC/�( �i/JG6c72r
ADDRESS: 2/05 /11 IJcc K13
CITY: 5tbrav v&CPT STATE:
W4
ZIP: 9921 2—
PHONE: PHONE:
S6? -963-571)
FAX: CELL:
CONTACT NAME:
�,> 1 r tn/c-ui2r
PHONE: FAX: CELL:
CONTRACTOR NAME: RC31,t 6!l1$Lca2r
MAILING ADDRESS: .Ce6
CITY: STATE:
ZIP:
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DES RISE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
tee:Acce l-fcA2Sc LekGq- cc»eP• 51tDVi 3.
Tear Off
TOTAL COST OF PROJECT: $7
Q Overlay
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 • Ired to be submitted and subsequently approved before this application can be processed.
Date: ��j�0
Signature
IProject #_SeristY2=-_10-14—
i IECEiVED
u3 2013
CSV PERM!T CENTER
Updated 1-11-11 I JUtb ?F 7-7ry• ;page 1 of 1
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