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2013, 05-30 Permit App: BLD-2013-0986 ReroofsjY�'s ane � f valleyT Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (509) 688-0036 Fax: (509) 688-0037 Dermitcenter@sookanevallev.orq /,9C- L.L'f - &' 7 a' (Staff Use Only) PERMIT NUMBER:� / PERMIT FEE: "{ 87-7 6- REROOF CONSTRUCTION PERMIT APPLICATION �] COMMERCIAL SITE ADDRESS: /.) 7o5 1-.o n c1 ASSESSORS PARCEL NO.: [] RESIDENTIAL LEGAL DESCRIPTION: BUILDING OWNER NAME: NAME: le yl e< (. ADDRESS: CITY: PHONE: Ft -‘11 /441r f 5' Z--4) /t5 STATE: lid c ZIP: Q p�✓I �� vy FAX: CONTACT NAME: Vie PHONE: �a 1- 724 -AA( 4' CELL: 9900 50--15'c? 53L5 CONTRACTOR NAME: FAX: 5%5—?z–r( CELL: MAILING ADDRESS: Q'Q(, S CITY: PHONE: 501 - Z l �- J --t / FAX: 0/ CONTRACTOR LICENSE No.: STATE: CELL: ZIP: pforyy EXPIRES: CITY BUSINESS LICENSE NO.: DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: Ft Tear Off 0 Overlay 3©©C) TOTAL COST OF PROJECT: $ 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 - permit or ap�.val for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional information may be required o be submi - an. - -• 1- • =.proved before this application can be processed. Signature �� Date: 5- •• 0-12 Updated 1-11-11 Page 1 of 1 http : //www. spoka n eva Iley. org/fi lestorage/ 124/938/210/948/ 1496/Reroof_Perm it_1-11-11. doc