2016, 02-23 Permit App: BLD-2016-0509 Re-Roof Community Development Department
crrrOF Permit Center (S6f IP e :111121 'ii lllq
Spokane 11703 East Sprague Avenue, Suite B-3 r._ /
Spokane Valley, WA 99206 PERMIT NUMBER:''
Valler Tel: (509) 688-0036 Par
Fax: (509) 688-0037 PERMIT FEE: •raw
permitcenter@sooka nevallev.orq
REROOF CONSTRUCTION PERMIT APPLICATIONT CENTER
❑ COMMERCIAL
A RESIDENTIAL 1 t
SITE ADDRESS: )16'11, )---1 KIQ ri e— - 2 '
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: r-:.-...0\).1--1, CV((\\ p Phan
L U han
ADDRESS: ) " '1_ L)111-(., rl Ci/ `g V.
CITY.: S p c)1 6D V(/j)l t i/ STATE: l 6)) ZIP: 9 9 0 u
PHONE: FAX: CELL:
CONTACT NAME: 1-()W
PHONE: FAX: , CELL:
CONTRACTOR NAME: oDa. kL0
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MAILING ADDRESS: n Ed, N G)4011)
CITY: t•1ics'V �1 STATE: l Aio ZIP: / �
PHONE: eg.\\A_
b�& y FAX: CELL: °6\9 1- `6-
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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 or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required t be submitted(� and) subsequentl4ved before this application can be processed. /
Signature `J Ni2)/1,/-it/14,� Date: 21;0 0.Il"
Updated 1-11-11 Page 1 of 1
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