2012, 06-14 Permit App: BLD-2012-0738 Reroof, TrussesSikkim
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Community Development Department
Permit Center
1170?East Sprague Avenue, Suite 8-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
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D•
0
.070
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE: 4 ( 57.7
REROOF CONSTRUCTION PERMIT APPLICATION
1
El COMMERCIAL /' ' ! RESIDENTIAL
SITE ADDRESS: 23 o7 �� licv4L�oriNtry
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: 13 4 (r/1/ Pc -6,--7
�04 L;/// 4 A/
ADDRESS: Mem
/3o 2 /� /del 75 d kP/
CITY: SAD /c /1 /La— /A '-c t f STATE:
pro p-.3 Yc
NAME:
PHONE:
4—
ZIP:
FAX: CELL:
CONTACT NAME: )pcc Mao? /`02c•
PHONE: .5-0 2- 3C7L- Cr) t/ Y FAX: // CELL:
CONTRACTOR NAME: ,S,ttc X S%toc Coo, f r✓ c�, vr, �i_
MAILING ADDRESS: c2 0 .5—lam Ai St/ (,y
CITY: l_. i b2r' T Ly Lc �( Y�
PHONE: 5-0 /
STATE: 't- (1
FAX: - CELL:
ZIP:
5b5-5iz
CONTRACTOR LICENSE NO.. ✓ "" P EXPIRES: CITY BUSINESS LICENSE NO.: 663 (f % • U 7 .12
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
✓r &Uw� f 4“ /de 41— //� 5f CJ G4,2 -/f
(, J' / /00—Os,--4a , A' -)30/r',
Tear Off // Overlay
TOTAL COST OF PROJECT: $
76 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 co. - Referenced codes a e available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not • .er- it or approval for a violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be require. o b= submitted and subse uently approved before this application can be processed.
Signature
Date:
Updated 1-11-11
Page 1 of 1
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