2014, 06-04 Permit App: BLD-2014-1285 ReroofSpokane
do,Valley
Community Development Department
Perniit Centhr (Staff Use Only)
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206 PERMIT NUMBER:
Tel: (509) 688 0036— "720 -51.2V0 PERMIT FEE:
Fax: (509) 688-0037
oermitcenter@sookanevallev.orcI
REROOF CONSTRUCTION PERMIT APPLICATION
Et COMMERCIAL
SITE ADDRESS:
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME:
NAME: �,c vItC �r1GXa ru /4
RESIDENTIA
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LEGAL DESCRIPTION:
ADDRESS:
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CITY: c��® ,pe !' w�7� STATE: `V 9 ZIP, fr027 C7
PHONE: /cop) $ 'P- ....?9673- FAX: CELL:
CONTACT NAME: S -l9 T
PHONE:
FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY:
STATE: ZIP:.
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
Tear Off f Overlay
TOTAL COST OF PROJECT: $ 9 '
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: 6—
Updated
-
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof Permit_1-11-11.doc