2013, 05-07 Permit App: BLD-2013-0819 Tear off, ReroofSpcikan� e�
®=valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
pe r m i tce n to r (s oo k a n ev a I l e y. o rq
(Staff Use Only)
PERMIT NUMBER:
S
PERMIT FEE: /29 7
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL
SITE ADDRESS:
❑ RESIDENTIAL
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME:
/-/pr%e r5
ADDRESS: / (' 2' V V '- 6 t -4-)°
CITY: j (i ��-C t1 `' �n �! C L.� STATE: ,0\
PHONE: / l/ FAX:
ZIP:
CELL:
CONTACT NAME:
PHONE:
E04 2,1
59 o
FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY: 2
/ o%C a
PHONE: 39? 0/ U 2
STATE:
INS
ZIP:
99223
FAX: CELL:
CONTRACTOR LICENSE NO.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
❑ Tear Off
TOTAL COST OF PROJECT: $
❑ Overlay
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit s 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: k` `7 / 3
Method of payment: ❑ Cash ❑ Check
Bankcard #:
❑ Visa ❑ Mastercard
EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
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10.28.07.doc