2016, 02-10 Permit App: BLD-2016-0383 Re-roofCommunity Development Department
Permit Center
SCYrYokane 11703 East Sprague Avenue, Suite B-3
p Spokane Valley, WA 99206
I
Valley Tel: (509) 688-0036
�' Fax: (509) 688-0037 �
permitcenter@spoka neva Iley. org
REROOF CONSTRUCTION PERM
E COMMERCIAL
SITE ADDRESS:
FPSI�711�q
PERMIT NUMBER: r
nib,
PERMIT F��:s
r' --SV PEPWF CENTER
T LrC-ATIjO NE / -
RESIDENTIAL
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: '���.� f o✓- 1�1E��
NAME:` -f j� �-
ADDRESS:
CITY: �lJ�� L�C� STATE: `2 ZIP:
PHONE: ���} �3 ^ �/ l/ FAX: CELL:
CONTACT NAME:`;z,
PHONO jO ` J �I I D, FAX: CELL:
CONTRACTOR NAME: 7
MAILING ADDRESS: SO O -S— 1.�2 SGf �r
CITY:
PHONE:
FAX:
STATE:
CELL:
ZIP:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
Tear Off] Overlay
TOTAL COST OF PROJECT: $ X/,yP��
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 v, lation of fede , state or IocgWa'9s, codes or ordinances. 6) Plans or additional
Information may be qulred ta-be-submitted and subsequen ly approv efore this applf ation can be processed.
Signature- �� Date: '16
Updated 1-11-11 Page 1 of 1
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