2011, 12-20 Permit App: 11003937 Tear Off, ReroofCITY of cv.
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Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tei: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spokanevallev. orq
(Staff Use Only)
PERMIT Num ER: 1 1
PERMIT FEE:
REROOF CONSTRUCTION PERMIT APPLICATION
Q COMMERCIAL $RESIDENTIAL
SITE ADDRESS: 32 t Lick,
ASSESSORS PARCEL NO.: LEGAL QESCRIPTION:
BUILDING OWNER NAME::: Ea-aibeJ a, /� CoZ&U /�) L. �ri.J C
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NAME: ' �_ 3'\' ( Y v / 1 jEL( AV c i���ljjjv qi `i-F/J
. .
ADDRESS:
CITY: STATE: ZIP:
PHONE: /
CONTACT NAME: /14/� ZI J.41
PHONE:
FAX:
FAX:
CELL: 677-78 F 8 3)
CELL:
CONTRACTOR NAME:
Ccs G S C` 11'J
MAILING ADDRESS:
(911- , t
CITY: (�l C� /'_/ iso STATE: Qt'//vn1 ` ,.,�� ZIP: 1 2Q
PHONE: �r�q c�C 5I —S FAX: ,////� 1 `-!"2S2, toSELL: as� '7�
CONTRACTOR LICENSE NO.; 3L-JGOC 69 3 'FIRES: y'/ /L3 CITY BUSINESS LICENSE NO.: J( 33 Lf' 2
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
14rfif-2 / -62 - on
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TOTAL COST OF PROJECT: $ v
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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 r ed tottke submitted and s bsequently approved before this application can be processed.
Signature (
Date: I2_/2b/ (/
Updated 1-11-11
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