2013, 09-10 Permit App: BLD-2013-1816 Tear Off, Reroof :l .
'Community Development Department ••••••.. �•.
Permit Center. • • • •:.(Staff U9e GOO.: --
:.11703 East Sprague Avenue,Suite B-3• , :
Spokane valley,WA 99206 PE•RMIT NUMBER. �1.
Tel (509)688-0036 'a-�• I •
.:Fax: (509)668-0037-.. ...~ -PERlIIT FEE•
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• ' • - '.-REROOF CONSTRUCTION PERMIT.APPLICATION '•:•' ' : =
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• " . .•SITE ADDRESS: I) D1q �. Z Ur • ,
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••.•. . .'ASSESSORS PARCEL NO.: • '' 1 LEGAL DESCRIPTION: :-.' •'
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••:"-- %. BUILDING OWNER NAME: (,1 ' '
1100RESS: •" v... et:J2I, ./. • �CITY: STATE: •JPojcc. IP: °� tE. r.
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PHONE :. FAX:
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• CONTACT NAME: <�� 1,LKU► 1>� " t ......
• • PHONE: Oot• -°AGI I. 4co�O'! ,lFAX. •:±CEI L:• G,:V fl i_•fl f V1 f T GEN ! i ..**•-• .y
. %-..* •:- CONTRACTOR \
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NAME:
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PHONE: 5v \ "I :41441 ... FAX S 0 CI• I occt, "11D
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;: • ONTRACTOR LICENSE NO.: gO4T{5(.,CS EXPIRES: L�. ,
(`l i CITY BUSINESS LICENSE NO••
•• :... DESCRIBE THE SCOPE OE WORK IN DETAIL AND INDICATE.U.S :.::":..... ::... •, '"'-•.....:.':-..•. • .•••. •:•_`-•..;•'''
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DISCLAIMER •'
•- "-The permitted verifies,acknowledges and agrees by their signature that:1)if this permit is for construction or on a dwelling,thedwelling is/wil •
"be served by potable water. 2)Ownership of this City of Spokane Valley permit inure to the property owner.3) The signatory is the pr
owner or has permission to represent the property owner in this transaction. 4) All construction iso be done In full compliance with the-City •-:•:..
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center.5) The City •
Spokane Valley permit is not a permit or approval for any violation of federal,state or local laws,codes or ordinances. 6) Plans or additlona ,
.:, •• •.;. .., Information maybe required to.be submitted anal subsequently approved.tii<fgre this application can t>e processed, '
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• :• Signatur
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., .• Cash ..0 Check, ':Cl.Master rd...
: method.of R@Yment: p. ' .. FEDACT .
Bankcard �t REDACTED_. . — EXP: RFPACTED vinic. •
Authorized Signatu
Effective October 28,2007 .., :' Page 1 of 1
' • .--•P:Kornmunity Developmept\02 Administration.NO3.Forms-Official Vers. loo s.Termit Cerlter\Reroof Construction Permit App,
0.28,07.doc••. .�.
- - This document originally contained
•••• •••• •. • confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN G52014-030.