2012, 04-13 Permit App: BLD-2012-0378 Reroof Community Development Department 4'La�'ZO —037 .'
all,(3F Permit Center (Staff Use Only)
e SpoKane
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206 PERMIT NUMBER:
Valley Tel: (509) 688-0036..00
Fax: (509) 688-0037 PERMIT FEE: 7/5-. 25—
perm itcenter(casooka neva lley.orq
REROOF CONSTRUCTION PERMIT APPLICATION
dl COMMERCIAL V
RESIDENTIAL •SITE ADDRESS: /76 (;z/ . ScCyese cSP°kcst t'(Q. Ve-4/ / L-0)4
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: L
BUILDING OWNER NAME: •
NAME:
ADDRESS: •
CITY: STATE: Zip:
PHONE: FAX: CELL: • • .
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: f j Y$ .-j--- Dc.e i o P_ c)• -;1 i-v I .
MAILING ADDRESS: • P D. Bc,k /93
CITY: .5,E,/, Q i.,(___e__ STATE: (/ti, .ZIP: 77Z/7
PHONE: 509 (7qq . '6_.5"-- FAX: 74/7 3/7/ CELL: • '
CONTRACTOR LICENSE No.: Q li[ vPi Ie _ EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
R 10 0— •
Tear Off 0 _Overlay" /i
TOTAL COST OF PROJECT: $ 9. 5-00.
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 submited and subsequently approved efore this application can be processed.
3/ZUpSignature i ,��i /47 Date: V /3//Z—
Updated
dated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof Permit_1-11-11.doc