2009, 12-14 Permit App: 09003962 Demolition Fire DamageSpokane
Valley .
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter(usookanevallev.org
(Staff Use, Only)
PERMIT NUMBER: / 3cief '71
PERMIT FEE:
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: ` AO 5. ,Qo6,:,11-100
ASSESSORS PARCEL NO.: qSa o 3 )) O 6
51
BUILDING OWNER NAME: "roto fit /a/LKCie
MAILING ADDRESS: / 3 O 5 , ,L.O.e. r/ I-1 o 0.0
CITY: kA) Pie 1% ) Ie'I
CONTACT PERSON NAME: /'o `) 1--1 4 N Y
SI-,
STATE: kJ45J1 . �5 1 i✓
ZIP: 9 %02 d �o
PHONE: oZO (j ? 7.1.- 60 FAX:
CONTRACTOR NAME: )4e.`,/,S D ,`3,4 S -1-c.2 ice,,)4P
MAILING ADDRESS: P u.
CELL: dog4 4o - `10 3.5"
CITY: ` A fLCrA%
PHONE: aog--77l— 773 LI
STATE:
up: 8 3 0 3 .�
FAX: yZDo — 7702-625-0
CELL:
CONTRACTOR LICENSE No.: reLE 74 7
EXPIRES: Jo /14. CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
❑ Site Plan Provided ❑ Notice of Intent #
El Spokane County Utilities has approved the disconnection
Describe the scone of work in detail
f e" t; ✓c L e 1 Ail fo t pose /=(..‘2c D M.i c -Foe 1,✓siocc. foe
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
Date: /,,,z - /4 - D q
Method of payment: ❑ Cash Elheck ❑Visa ❑ Mastercard
Bankcard #:
EXP: VIN#:
Authorized Signature:
CFi...rti..i. rl..F.+4..... .10 7r\r1-1
r)....,. 1 i.i
1320 5. ROBINhOOD 5T.
4
4 4 ,
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r lRf PAM/V:4_
SCALL: I " = 20'