2015, 05-27 Permit App:BLD-2015-1208 Re-Roof Community Development Department
Permit Center (Staff Use Only)
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11703 East Sprague Avenue, Suite B-3
pokane Spokane Valley, VSA 4920 PERMIT NUMBER:
4.00 Valley Tel: (509) 688-0036
Fax: (509) 688-0037 PERMIT FEE:
Dermitcenter@sookanevallev.orq
REROOF CONSTRUCTION PERMIT APPLICATION
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COMMERCIAL X RESIDENTIAL 9 (�-
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SITE ADDRESS: �
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME:
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ADDRESS: V 5 1- V • 6 .
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CITY: , V STATE: ZIP: • , IP �. s -_
PHONE: MEE& FAX: --- -- CELL: I. •— n"f •3
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CONTACT NAME: a
PHONE: S 16iAllit, `e FAX: CELL:
CONTRACTOR NAME:
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MAILING ADDRESS:
CITY: _JOE:
.ZIP:.
PHONE: FAX: CELL:
CONTRACTOR-LI� SE11� E No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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TOTAL COST OF PROJECT: $ 1 I Qu ":),D
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 Develo.ment code. Reference. .des are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley per, Is •t a permit or appr'.val f.r any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may .- require. to be submi -d - . ..sequently approved before this application can be processed.
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+��� �_`.� Date: kr)--)ignature (
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof Permit_1-11-11.doc