2015, 08-03 Permit App: BLD-2015-1828 Re-roofCommunity DevalDpment Department
CITY OF Permit Center (Staff Use Only)
SpokaneSpokane11703 East Sprague Avenue, Suite B-3
Valley, WA 99206 PERMIT NUMBER:
VTalley Tel: (509) 688-0036
� Fax: (509) 688-0037 PERMIT FEE:
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REROOF CONSTRUCTION PERMIT APPLICATION
Cl COMMERCIAL RESIDENTIAL
SITE ADDRESS: / '4"" s xt�- A-), „� n
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS: Rol< J
CITY: ��(1�c � �� STATE: 4 ZIP: � j( j Z
PHONE: /5�� 0 — (1/ Y FAX: CELL:
CONTRACTOR LICENSE NO.: lJjaZl Yj yJ EXPIRES: (5111G CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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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 or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be required to be submitted and subsequently apprroyg fore this application can be processed.
nature��- Date: ,, - z '/SJ
Updated 1-11-11 Page 1 of 1
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