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2009, 12-07 Permit App: 09003902 Fire Damage Demolition00/1\ft... si�iz;41llImm�n .001sValley. 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.orq (Staff Use Only) 77 PERMIT NUMBER: r1 ,C/el (/ PERMIT FEE: DEMOLITION PERMIT APPLICATION PROJECT ADDRESS: ?4o 7 c 164:; /9L -'C , ASSESSORS PARCEL NO.: 43-6 74, J0;2 5 BUILDING OWNER NAME: &A/ / c c - MAILING ADDRESS: 6 '10 L )4' x w C� CITY: St90 9,^'c- V))) e `� J CONTACT PERSON NAME: /`i 9 h PHONE: STATE: A4)511:^1511)),-) ZIP: 9 J,2 I Z FAX: CELL: CONTRACTOR NAME: Kl e.`.,✓ 5 L 5 A 5 fa-- h Iec ✓7/ MAILING ADDRESS: /or / , x 300 CITY: PHONE: 708 7v. - 773 4 CONTRACTOR LICENSE No.: 7/j1 FAX: ,20-77),-(e�5/b CELL: EXPIRES: / //) © CITY BUSINESS LICENSE NO.: PROJECT DESCRIPTION (Please Provide Site Sketch) Ei Site Plan Provided 0 Notice of Intent # Spokane County Utilities has approved the disconnection Describe the scope of work in detail Qc/9•`4 l EC /69M95 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: Method of payment: ❑ Cash l -Check ❑Visa ❑ Mastercard Bankcard #: EXP: VIN#: Authorized Signature: Effective October 28, 2007 Page 1 of 1 P:\Community Development\Forms\Building forms\Demolition Permit App.1.doc