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2014, 05-15 Permit App: BLD-2014-1075 Reroof Community Development Department •„,� Permit Center (Staff Use Only) CITY Spokane 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 PERMIT NUMBER: Valley Te (509) 688-0036 400, Fax: (509) 688-0037 PERMIT FEE: permitcenter@spokanevalley.orq REROOF CONSTRUCTION PERMIT APPLICATION gid' COMMERCIAL J f y RESIDENTIAL SITE ADDRESS: 1y/'C/ A-w i $1 ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: BUILDING OWNER NAME: jJc,k , ( . • NAME: ADDRESS: • CITY: STATE: ZIP: PHONE: FAX: CELL: CONTACT NAME: PHONE: FAX: Q / CELL: \ CONTRACTOR NAME: (j �/��[ �lrtp/' ( AIDS c-� �J ' MAILING ADDRESS: •/S 7 49-mict)--e__ • CITY: latx' STATE: (. J-111--111— ZIP:. f97,,(31 PHONE: J O — Q�W �O v FAX: � CELL: CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.: D CFjE( HE SCOPE OF WORK IN DETAIL AND INDICATE USE: El Tear Off ) Overlay TOTAL COST OF PROJECT: $ 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 appr:val for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional information may be require o be su itte. • . ubsequently approved before this application can be processed./J Signature Date: ,//�a Z.6 ( Le/ Project #' LIX '1O(? RECEIVED MAY 15 2014 ,i (L„ • CSV PERMIT CENTER Updated 1-11-11 # REV. # Page 1 of 1 http://www.spokanevalley.org/filestorage/124/938/ of_f crmit_1 11 11.doc