2012, 06-26 Permit App: BLD-2012-0985 ReroofFValey.
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenterTsooka nevalley.orq
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(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
REROOF CONSTRUCTION PERMIT APPLICATION
0 COMMERCIAL
SITE ADDRESS:
\%fl S N 2.,u.Yef
RESIDENTIAL
ASSESSORS PARCEL NO.:
LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME:
ADDRESS: �l �i.a/�/f ,,//&Echec,..
CITY:rtH
STATE:
ZIP:
q90.37
PHONE: ? — FAX: CELL:
CONTACT NAME:
PHONE: )a o --m S ./ y{y) /; to �,/ FAX: /
CONTRACTORd�
NAME: R6 F/v(e,O-p•4,4i
CELL:
�3U 266 DP,
MAILING ADDRESS:
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CITY: (�
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STATE:
tJo,
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( 44,.x_ -c.„
ZIP:
PHONE: ✓ Jag re/V - 00- FAX: (% // CELL: - ('n QQ
CONTRACTOR LICENSE No.: ,.L /1 �a LAt 95 / EXP ES: -f /idyl) CITY BUSINESS LICENSE NO.: caz 7 o a (d_
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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ear Off Overlay
TOTAL COST OF PROJECT: $ LY Yr
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 s 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 ubmitted and' bsequentiy approved before is application can be processed.
Signature
Date:
Updated 1-11-11 Page 1 of 1
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