2016, 03-14 Permit App: BLD-2016-0785 Re-Roof Project C� �l?/&—D78
Community Development Department
CITY OF ti Permit Center (Siiff-{3se� 1W)E 0
S�O��„� 11703 East Sprague Avenue,Suite B-3
11 Spokane Valley, WA 99206 PERMIT NUM ,.1 '�
Tel: (509) 688-0036 : ir. T[crit;
Valley Fax: (509) 688 0037 PERMIT FEE:
permitcenter@sgokanevallev.orq 0 3 V I_c n(_ , k.`i\d I L hi
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REROOF CONSTRUCTION PERMIT AF Eltiii�O�N REv '” f_-___ IJ
Ci COMMERCIAL ❑ RESIDENTIAL
SITE ADDRESS:
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: �
NAME: 0/ e
4,/, 6,- `���C�iZc�L
ADDRESS: 77 G 3 ,8C77d /' I IK`
/O`
CITY: S",e01Z�E (/Q ///e �/ STATE: W4 ZIP: �/✓L/Z
PHONE: ( i79) . ./ - ///,/ FAX: CELL:
CONTACT NAME:
PHONE: ( O 9 ) . .S 77 -// ( / FAX: CELL:
CONTRACTOR NAME: ro//7e,P
MAILING ADDRESS: 7/2Z t 'c76/wiJ 1417--
e
ITY
C : J0a!%j e Ko//L y STATE: Y�i7 ZIP: ,R92/2/ 2
(4-0 PHONE: 9) ..S/ - //-/ FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
❑ Tear Off �� 0_1!)
DISCLAIMER 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 requir-. o be submitted and subsequently approved before this application can be processed.
Signature Date: ?// L/L Lv(
Updated 1-11-11 Page 1 of 1
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