2015, 03-02 Permit App: BLD-2015-0357 Reroof5']
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@spokanevalley.org
REROOF CONSTRUCTION PERMIT
Project
PERMIT NOM 2 2015gC
PERMIT FEE:
I.JV rtnlvll 1 t.CIV I CFS
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❑ COMMERCIAL 141 RESIDENTIAL
SITE ADDRESS: (33 0 if E.. 1-1-cra1
ASSESSORS PARCEL NO.: LE L DESCRIPTION:
BUILDING OWNER NAME: )1/401\tC\r\a.t`
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NAME:
Nllckact 1Jo.lka.r
ADDRESS: 13 30 s E.. i-i•crO �{ A -v
CITY: 5?aCo •C- Vc.\t , J
PHONE: (5-04) 932 -/y97
CONTACT NAME: M Lc c t
PHONE:(�9 \ q3. Z-14 17
CONTRACTOR NAME: s..}-GY, rt C
STATE:
LA) .3-1
FAX:
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Zip: 16(2_1 la
CELL: (roc) Li37- MI? 7
FAX:
Zr1 crt±s
CELL: (3-60 432 -/99
MAILING ADDRESS:
CITU:
STATE:
ZIP:
PHONE:
FAX:
CELL:
CONTRACTOR LICENSE No.:
EXPIRES:
CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
❑ Tear Off Overlay
TOTAL COST OF PROJECT: $
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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 al/L-- Date: 3/2./%S
Updated 1-11-11 Page 1 of 1
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