2016, 02-09 Permit App: BLD-2016-0357 Re-roofCommunity Development Department
Permit Center
SpokaneSpokane11703 East Sprague Avenue, Suite B-3
Valley, WA 99206
� V T���e� Tel: (509) 688-0036
Fax: (509) 688-0037
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REROOF CONSTRUCTION PERMIT APPLICA'TI6N
El COMMERCIAL
SITE ADDRESS.
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME:
RESIDENTIAL
LEGAL DESCRIPTION:
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NAME:
ADDRESS' /� �( �v✓ -�
CITY: 4 7Qt STATE: 64", ZIP:
PHONE:a•— FAX: CELL:
PHONE: SV 3O FAX:
� )� / '/ CELL:
CONTRACTOR NAME: .� —tX2<r/3/ An 1-7e-
MAILING ADDRESS: j �—
CITY:/jC STATE: ZIP:
PHONE: J �% `7 % FAX: CELL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE S O E OF WORK IN DET�L AND INDICATE USE' r�
Tear Off
TOTAL COST OF PROJECT: $ 5-60
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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, 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 or any vio Of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be required to se �pproved before this application can be processed.
Signature Date: -)- 4?1114.
Updated 1-11-11 Page 1 of 1
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