2013, 07-10 Permit App: BLD-2013-1354 Tear Off, ReroofSta e
.00Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
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(Staff Use Only)
PERMIT NUMBER:{{�tR�I-
PERMIT FEE: 't6. // 1b
REROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL 0 RESIDENTIAL
SITE ADDRESS: 8420 EAST NORA AVE., SPOKANE VALLEY, WA. 99212
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: JAN CARLSON
NAME: SAME
ADDRESS:
Cm:
STATE:
ZIP:
PHONE: 509-230-8654
FAX: CELL:
CONTACT NAME: JAN CARLSON
PHONE: 509-230-8654
FAX: CELL:
CONTRACTOR NAME: JAN CARLSON
MAILING ADDRESS: SAME
Cm:
STATE: ZIP:
PHONE: 509-230-8654
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
REMOVE AND REPLACESINGLE LAYER OF ASPHALT SHINGLES/TAR PAPER FROM ROOF
VENT EXISTING KITCHEN/BATH EXHAUST FANS TO ROOF VENT.
REMOVE AND REPLACESINGLE LAYER OF ASPHALT SHINGLES/TAR PAPER FROM ROOF
■❑ Tear Off El Overlay
TOTAL COST OF PROJECT: $ 4,900
}1ISCLAIMER
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 re.uired to be su itted and subsequently approved before this application can be processed.
t 1 . ,.y
Signatur
Date: 7/10/13
Method of pa ment: 0 Cash
Bankcard #:
0 Check
0 Visa 0 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
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