2013, 09-11 Permit App: BLD-2013-1824 ReroofSpokane
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Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688 003G 7.q0
Fax: (509) 688-0037
permitcenter(6sgokanevallev.orq
REROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL
RESIDENTIAL
SITE ADDRESS:
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
45a -!LF, 15fo
BUILDING OWNER NAME:
NAME: 11Jg/Q/5iv Fe41-1,PA7
ADDRESS: /3Z D 5 / -OX
CITY: 5,00, ,Jt Vr !'
PHONE: %- 9� / - /63/ FAX:
CONTACT NAME: .4-�(. Wt " - J 72)A-/
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r26,- 703 ( FAX:
STATE: I[ed4,s4.l1.3.%e7/i(ZIP:
CELL:
PHONE:
CELL:
CONTRACTOR NAME: (_ 4,1/.27d1 /55$7-0,64j D/V
MAILING ADDRESS: 31o? N Y 5u/ 6/4a/ /7
ZIP:. 2/L
CITY: SAke4iq& STATE:
PHONE: ce31 tP9j- 5---20 FAX: ? CELL:
CONTRACTOR LICENSE No.: CLi�AV/y .Ze EXPIRES: .J/12/45 CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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TOTAL COST OF PROJECT: $
/;f/7,/7
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 required to be submitted and subsequently approved before this application can be processed.
Signature Date:
1-2- a-oRECEIVL
�3
1 10P
CSV PERMIT CENTER
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof Permit_1-11-11.doc