2013, 10-01 Permit App: BLD-2013-2012 Tear Off, Reroofr.
*Wan e
Malley.
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite 6-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
perm itcenter(Tspoka neva) lev. orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
KCKUUr LUNY, 1 KUL 11UIV VCKPH. 1 AYYFIGPI r.wrl
El COMMERCIAL
SITE ADDRESS:
is RESIDENTIALect
{ RECEIVED
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
1 UC I LI 1 2013
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NAME: r &cz, itc4
CSV PERMIT CENTER
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ADDRESS: 9111 f, tJeA�^1J / `v4
I CUP nt I RF\! -BF
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LITY; L/rfl
PHONE: 9a
CONTACT NAME: j Gr y Iiy
FAX:
'91%qS
CELL:
PHONE: 14 FAX:
CONTRACTOR NAME: k J; ut i )2> Tr6s.c'
CELL: �p;yrQ
MAILING ADDRESS:
(521 E J r ae. Ave
99076
CITY: s7bkebr(» 451STATE:4,1A) ()/Q ZIP:
PHONE: / Jl - ?710 FAX: `) C 3 /27
CONTRACTOR LICENSE No.:.1 /A RC51 EXPIRES:
CELL:
CITY BUSINESS LICENSE NO.:
DESCRIBE Tr S OPE�QF WORK I DETAIL AN 9 INDICATE USE:rr1;t416- e rr to
(o Tear Off
TOTAL COST OF PROJECT:
0 Overlay
7000 itP 1 3ect, # n`!56) _ l/ o,
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: YiCash ❑ Check
Bankcard #:
❑ Visa ❑ Mastercard
EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\02 Administration\03 Forms - Official Versions \Permit Center\Reroof Construction Permit App
10.28.07.doc