2012, 04-17 Permit App: BLD-2012-0410 ReroofSpokane
Permit Center
1170
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
VA'LleYe (509)688-0036 FAX: (509)688-0037
permitcenter@spokanevallev.ora
Community Development
Reroof Construction
Permit Application
&o-20/2 - Oy(o
PERMIT NUMBER:
PERMIT FEE:It/ 7 7 5, --
LI Commercial
KElliesidential
SITE ADDRESS: / a,�,0 "4- r
ASSESSORS PARCEL NO:
Building Owner: _ - - - -
Contractor: _ --
Name: dt ,,.,, wv: 5
Name: /,�Gue% /7(.,j , f n6cI
Address: C630 3 c g - 3
Address: / .2 adv & G d ,, sy
City: � '1pc ltis,c 414State: Zip: max,
City: Sot:Cea State _ Zip:
Phone: ( Fax:
Phone: s -)3Q_ S) % `1 Fax:
Contractor Lic No: Exp
�N�fRysfes Date:�el,,'3
Contact Person -- - - --_- _-
City Business Lic. No:�/G
5 iYyG 044, S
Name:
Phone:
Describe the scope of work in detail:
j2riear off n Overlay
Cost of project: $ 'yen,
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of 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) This 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.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Signature
Method of Payment:
❑ Cash
Bankcard #:
Authorized Signature:
Check
Date
❑ Mastercard ❑ VISA
Expires: VIN#:
Effective October 28, 2007
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P \Community Development \Building Division\Jodi-comm'I\PCF\Reroof Building Permit App doc