2013, 02-14 Permit App: BLD-2013-0237 Tear Off, Reroof Project #( -13- Z37 -1
RECEIVED
Community Development Department
Permit Center
CITY Or 11703 East Sprague Avenue,Suite B-3 (Sta Use On
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Spokane Valley, WA 99206 PERMITftI B
Tel: (509)688-0036
.��� �� nex Fax: (509)688-0037 PSE T E
PermitcenterOsookanevallev.orq 1111111 {"tel
REROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL / RESIDENTIAL
SITE ADDRESS: 6 . /2/D S O1//4 h f/ !VAC. Sf9D �u //-tom g fico
ASSESSORS PARCEL NO.:4501 • i2LEGAL DESCRIPTION: CUM- ,ZS� 7R Or
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BUILDING OWNER NAME: Inn ,
NAME: �/G4`I e / I o/Lev,9eXt�J
ADDRESS: E. ,Z,ds �o,- /rijrnl 4/e s
CITY: e/t / e'r SA* Ale //d//e/ STATE: '4 ZIP: 9/2 OG
PHONE: TO, — 474—g53 FAX: CELL: S'O3_ tog- 'QQy
CONTACT NAME: "Al,kr___ 66/e/7/71/1-7
PHONE: S--01_ / 2 7 .as-3 y FAX: CELL: 6-0 — 2 O-/ - 700y
CONTRACTOR NAME: 4",:.��-i Q c
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE/TH SCOPEr— Tai W IN DF�TeiD DICATE USE:
TTear Off Overlay
OTAL COST OF PROJECT: $ 7000. 00
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 /9.,, A ,sy,,0.-� Date: a--!y aof 3
Method of payment: El Cash ❑ Check ❑ Visa ❑ Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
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10.28.07.doc