2012, 09-10 Permit App: BLD-2012-1530 Reroof•
Spokane
7 COPY
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite 8-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
1
(Staff Use Only)
PERMIT NUMBER: '^� kJ — 12 --
PERMIT
2 -
PERMIT FEE: / 57 7 57;6/
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL
SITE ADDRESS: r7
ASSESSORS PARCEL NO.:
tSt. RESIDENTIAL
'p.-\
LEGAL DESCRI ON:
BUILDING OWNER NAME:
NAME:
Prk\le_ )r c h
ADDRESS: 1 C.,),2_11
cm►: \ x::11
PHONE:
FAX:
STATE: (t f
ZIP:
CELL:
CONTACT NAME:
.
PHONE: q29-- fg9 FA
CONTRACTOR NAME:
CELL:
MAILING ADDRESS:
.r Its. re,dee-Kyyl
�!;`�J�f n2 \i_n IIJ)/t. lSTTAATE:(� 7L� �n
PHONE: �1� 1 f""G) �Li ��� FAX: �cdV r '"/2R
CONTRACTOR LICENSE No.:, if f iilmYRASIti
ZEP:
CELL: Rciot 99Z --q107
CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETIIL AND INDICATE USE: CQtic,5l�t U`1�Q
EP0 t -4- (la -1u nu s
Tear Off 0 Overlay
TOTAL COST OF PROJECT: $ 9 cin
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 Qty 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) AR construction is to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the clty of Spokane Valley Permit Center. 5) The Gly of
Spokane Valley permit is not a permit or approval for any violation of Federal, state or local laws, codes or ordfnances. 6) Plans or additional
information may be required to be submited and subsequently approved before this application can -be processed.
Signature Date:
Method of payment: ■Cash Q C ck 0 Visa 0 Mastercard
VIN A .
Bankcard #: EXF-
Authorized Signature:
Effective October 28, 2007
Page 1 of 1
P:\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Reroof Construction Permit App
10.28.07.doc
Received Time Sep.10. 2012 12:58PM No. 9808