HomeMy WebLinkAbout2015, 08-08 Permit App: BLD-2015-1979 Re-Roof Community Development Department
Permit Center (Staff Use Only)
SCITY OFpokane\1111703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206 PERMIT NUMBER:
"17a11ey® Tel: (509) 688-0036
.•O
Fax: (509) 688-0037 PERMIT FEE:
perm itcenter@ spoka neva l lev.orq
REROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL M • ESIDENTIA / /
SITE ADDRESS:-1(57 l iv �t-C - -5��/4/lie (/ �l/�„' 160-
ASSESSORS PARCEL NO.: LEGAL DESCR PTION:
BUILDING OWNER NAME: / ti—PLZ/5 - r n-7'9
NAME: -Yet i �1 i- )G (2," -t /„
ADDRESS: Dc' 2 /L 4� eLC e
CITY:✓'a(�vl Of 1/g1/7 STATE: / ZIP: r�j�/
PHONE: S Ci'7 FAX: CELL:
CONTACT NAME: L7c3 (�g J, ci —ii ,&c-i, (2,4- -1' �
PHONE:
,-5 / — / 77 7 FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
-7— -q r c� . — `71,
Tear Off -S- Overlay
TOTAL COST OF PROJECT: $ 0( ± 0 i - ! S
v
DISCLAIMER (20
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 Developme. code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not . permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be require, to be submitted an. subsequent) .%proved before this application can be processed.
Signature _L Date:
S-- ---( ��
,L5
FOR INSPECTIONS CALL 688-0054
CHOOSE 3 - NORTH AREA
Updated 1-11-11
Page 1 of 1
C:\Users\rdanlel\Downloads\Reroof.doc