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2015, 03-25 Permit App: BLD-2015-0640 ReroofSponeGJ Valley Community Development Department Permit Center 11703 East Sprague Avenue, Suite 6-3 Spokane Valley, WA 99206 Tel: (509) 688-0036 Fax: (509) 688-0037 permitcenter©sooka neva I ley. org (Staff Use Only) PERMIT NUMBER: PERMIT FEE: REROOF CONSTRUCTION PERMIT APPLICATION ❑ COMMERCIAL RESIDENTIAL SITE ADDRESS: (aSQCDF. _CY\r._ (1 ASSESSORS PARCEL NO.: 4S j53?OS LEGAL DESCRIPTION: BUILDING OWNER NAME: NAME: 'le' ?G\ V114/\ ADDRESS: I Zr' O Cp l., (/ la (1 CITY: c` STATE: T r ZIP: PHONE: —1 (S 2 I S FAX: CONTACT NAME: (�f'Yvnf1i3�ktorPSy-1 PHONE: Li cz p Ti 1 S �7 FAX: CONTRACTOR NAME: 0 G "DQ&C dia CELL: —7U o,Z�lSs� CELL: MAILING ADDRESS: i Vl JY _ 1 3� CITY: PHONE: STATE: ZIP: % f) 1 CONTRACTOR LICENSE No.: FAX: EXPIRES: CELL: CITY BUSINESS LICENSE NO.: DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: f252 C.1/4 v Jr( 0, c_ ❑ Tear 00 TOTAL COST OF PROJECT: $ SO-de) Overlay 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 i5 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 /tom (IQ(' it Date: (23 a2 5 Project #817-rQnIS-0(ocfo RECEIVED RD MAR 2 5 2015 CSV PERMIT CENTER Updated 1-11-11 REV. C:\Users\rdan el\Dowwn o eef doc s ' Page 1 of 1