2013, 04-11 Permit App: BLD-2013-0622 Reroofr 1013 03:30p Spokane Roofing
Spokane"
Valley
COPY
Community Development Department
Permit Center
11703 East SpragLe Avenue, Suite 6-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
=ax:(509) 688-0037
(509)747-599U
P.l
REROOF CONSTRUCTION PERMIT APPLICATION
RESIDENTIAL
El COMMERCIAL
SITE ADDRESS' 2'-U 5 SOnO�‘t•
LEGAL DESCRIPTION:
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME:
S tm
NAME: 30.11 J‘Irii.MOO
ADDRESS: LI i S .-SOC\ l r CCCA-
CITY: -5(- KJ -IM—
PHONE:F.)---9-9- ka.Q.
CONTACT NAME:
STATE:
FAX:
PHONE:
CONTRACTOR NAME:
01464
FAX:
CELL:
CELL:
MAILING ADDRESS: 1 50 C .�C-TRICV - hit
STATE: WA
CITY:
PHONE
CONTRACTOR LICENSE No.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
FAX:
EXPIRES:
z1p: ciCi ZG Z -
CELL:
CITY BUSINESS LICENSE NO.:
L
Tear Off � Q 2—C Th
TOTAL COST OF PROJECT: $
❑ Overlay
DISCLAIMER
s
or constn:ccion or on a dwelling, the
will
ecc.r re ' 3y �tabie water. 21) Ownership of th s Cityeof Spokane Valley 1permitsInurre l
to the dwelling
e property owner. 3) The sig atory s tre property
owner or has permission to represent the property owner in this transact on, 4) All construction is to 7e done i. full compliance with the C ty of
Sookane Valley Development cc6e. Referenced codes are available For review at the City of Spokane Valley Permit Center. 5) Tne City of
::::!,<are `!alley per,Tiit is n.Ot a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or a:::ditional
.r :rine: may be required :o be subrni:ted and subsequently approved before th s application can to processeo
Signature
Methoe of payment: ❑ Cash ,,,,JO Chic 1 , 7
6ankcaro kvv!REIACTED
Date:
isa 0 Mastercard
EXP: �(C-3 VIN:*:
This document originally contained
AJEnorized Signature: l _r REDACTED conndential credit card information which
was redacted pursuant to RCW 19.255.010•
and the original document_ Syed
October 28. 2307
pursuant to SOS DAN G52014-030.
=_°fectrve Lnit
=: ,C:,mrnmt.rity Deve!opment\02. Administration\U3 rcrms -
10.?9.0dpc,7!Versions\Permit :enter\Rerocf Cui�s[iuct on ?
ge 1 of 1
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