2012, 04-09 Permit App: BLD-2012-0318 Tear off, ReroofWine
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Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter(@spokanevallev.org
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE: l
REROOF CONSTRUCTION PERMIT APPLICATION
J COMMERCIAL #] RESIDENTIAL
SITE ADDRESS: ( ) 0 'N) c --d., �0 01) Q
ASSESSORS PARCEL NO.: LEGAL(DESCRIPTION:
BUILDING OWNER NAME:
NAME: C/ )SQn lA)RYCI
ADDRESS: U�"o/O ij 6(�r )J Lout; i•
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STATE:
ZIP:
PHONE:
CONTACT NAME:
FAX:
CELL:
PHONE: CELL:
FAX:
CONTRACTOR NAME: 1/ eY L CK. lci ylij 2/. C,
MAILING ADDRESS: CH 'ST- n A455(6f)
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PHONE: _\2,1 - 0q /7
CONTRACTOR LICENSE NO.: MO `6015L-
CITY:
STATE:
FAX:
CELL:
EXPIRES: Ca
DESCRIBE THE? SCOPE OF WORK IN DETAIL AND/S
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DICATE USE:
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ZIP: I`�I! (L
12)- SOL»I
CITY BUSINESS LICENSE NO.:
Tear Off Overlay
T TAL COST OF PROJECT: $ coc 9 q, f l
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is far 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 r appro .I for any violation of federal, state or lace/ laws, codes or ordinances. 6) Plans or additional
information may be required t�be subbn't .• -nil • bsequently approved before this application can be processed.
Signature
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Updated 1-11-11 Page 1 of 1
http://www.spokanevailey.org/filestorage/124/938/210/948/1496/Reroof_Permit_1-11-11.doc