2016, 04-05 Permit App: BLD-2016-1118 Re-Roof Community Development Department 611 /l/
Permit Center (Staff Use Only)
S4ö1 '
TY 11703 East Sprague Avenue, Suite B-3
ane Spokane Valley, WA 99206 PERMIT NUMBER:
57,9
Valley
Tel: (509) 688-0036 APR 0 52016
Fax: (509) 688-0037
oermitcenter@ spokanevallev.orq PERMIT FEE:
IT CENTER
REROOF CONSTRUCTION PERMIT APPLICATIOF
0 COMMERCIAL RESIDENTIAL
SITE ADDRESS: SOS ri%v!e 5
ASSESSORS PARCEL NO.: LEGF(L DESCRIPTION:
BUILDING OWNER NAME: 7'
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NAME:
ADDRESS:
/5:25 5, pf✓G�re 55 �j 7
CITY: ����I C�i1 e /7/, STATE: L.1v/ ZIP: ` 9.-3
PHONE: J FAX: CELL:
CONTACT NAME: /,2711d
PHONE: S —9f9-WA3 FAX: CELL:
CONTRACTOR NAME: j5m cf. /1 StC 'i
Gx
MAILING ADDRESS: /S I J E j /11(./
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CITY: � �' �/ STATE: /4,/,4 ZIP: 9 ')7
PHONE: FAX: CELL: S�p a �p/
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CONTRACTOR LICENSE No.: J FMCgCLgXPIRES:/I/I207 CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
r454,77 /rte- ,,v7C
J(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 to be submitted and subsequently approved before this application can be processed.
Signature % ""'`�- Date:
Updated 1-11-11 Page 1 of 1
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