2015, 08-04 Permit App: BLD-2015-1838 Re-roofCommunity Development Department
CITYOF Permit Center (Staff Use Only)
SpokaneSpokane11703 East Sprague Avenue, Suite B-3
Vailey, WA 99206 PERMIT NUMBER:
Valley Tel: (509) 688-0036
� Fax: (509) 688-0037 PERMIT FEE:
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permitcenter@spokanevalley.org
REROOF CONSTRUCTION PERMIT APPLICATION
n COMMERCIAL RESIDENTIAL
SITE ADDRESS: 2 ED
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ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME:
ADDRESS: S .
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CITY:)\l
STATE:
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ZIP:
PHONE:
FAX:
CELL:
CONTACT NAME: l JVD
PHONE: - Q - e�-7 ro
FAX:
CELL:
CONTRACTOR NAME:�r-
MAILING ADDRESS: 6 e rY'-
CITY:
STATE:
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ZIP:
PHONE: j GI - �Z��
FAX:
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CELL'
CONTRACTOR LICENSE NO.:
EXPIRES:
CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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TOTAL COST OF PROJECT: $ 7 0 _J S/ 0 --
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 S okane Valley it Inure to the property owner. 3) The signatory Is the property
owner or has permission to represent the property this transa n. 4) All construction is to be done in full compliance with the City of
Spokane Valley Developmen . Refere co are availab for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley per not a perm ppro or any violat of federal state or local laws, codes or ordinances. 6) Plans or additional
Information m e required to be I d subsequently pproved befole this application can be processed.
Date: �- t/--1
Updated 1-11-11 Page 1 of 1
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