2011, 08-31 Permit App: 11002674 Tear Off, Reroof •
Community Development Department
Sjökane
Fti_�,° Permit Center Staff Use Oply)11703EastSpragueAvenue, SuiteB-3 f Spokane Valley, WA 99206 PERMIT NU ,�R: + 1- 1
Valle 4000 Tel: (509) 688-0036 7
Fax: (509) 688 0037 PERMIT FEE:
permitcenter@spokaneva llev.orq
REROOF CONSTRUCTION PERMIT APPLICATION
0 COMMERCIAL X RESIDENTIAL
SITE ADDRESS: C>3 -S- d -L y`-L-z_c,,cl
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: ,DC%c/• ,, Q
ADDRESS: ��pz,3 S Jl ctymOn q/ •
CITY: � (���C/i��4 l� Q/ // y STATE: ZIP:
PHONE: . ^(9 ) 7/ )— 3 (...,4-7 / FAX: CELL:
CONTAC AME: //
PHONE: FAX: CELL:
CONTRACTOR NAME: ./a/2em,ta,h/e (7,, / r 3 T,-, c
x
MAILING ADDRESS: - 3�/,. — /L! cin
CITY: -C (.4''c,7-e° STATE: �� ZIP: 9/9.--,?/ c /
PHONE: 5C 6 5) 7— 7/7� FAX: CELL: 91.��� /O/S�
/
CONTRACTOR LICENSE NO.: (Ore/J/2,A4e#1L,O4EXPIRES: CITY BUSINES LICENSE NO.: Q Z3�",,
DESCRIBE THE SCOPE OF WORD IN DETAIL AND INDICATE USE:
/ / ay.'r— 72 qr- o 13'PP/. C/ `/ Z?4 :r/�'�' fi P4-27 ��/:,1/ � .5-"7..--V7D C i/y,ef j r cca,I/r r co,-t -v/Yr /S✓Y /7
/57°V
Tear Offrr�� d Overlay
TOTAL COST OF PROJECT: $ TSZ C. `9 C)
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. •eferenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a p" - or appro�fr a violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to .- ..mitte9..8'nd subs uently ap foved before this application can be processed.
Signature j Date: y../
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Updated 1-11-11 Page 1 of 1
http://www.spoka neva I ley.org/fi lestorage/124/938/210/948/1496/Reroof_Permit_1-11-11.doc