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