2016, 03-25 Permit App: BLD-2016-0963 Re-Roof Pi % Community Development Department
Permit Center (Staff Use Only
►�cry oa 11703 East Sprague Avenue, Suite 6-3 ;'• E C E I V E D
pok.rle Spokane Valley,WA 99206 PERMIT NUMBER=
\iilleye Tel: (509) 668-0036
Fax: (509) 688-0037
i ermItcenter( spokanevalley_.om PERMIT FEE:
T. CENTER
REROOF CONSTRUCTION PE ' MIT APPLICATION
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COMMERCIAL d' ' E�IDENTIAt
SITE ADDRESS: e: /J �...✓ 4 A i ,
ASSESSORS PARCEL NO.: LEGAL DEr(TION,
BUILDING OWNER NAME: /�,L ir �-i� '� / •/31-1/L)
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NAME: I L.�
ADDRESS: OA,'/ I `il /�I ./ 1.e/
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CITY: �� 1 Al. / `/._�/ STATE: - A ZIP!
cie:m ,
PHONE: (0, q/ 6 4.x: C CELL:
CONTACT NAME:
PHONE: 2.34 0_4.7-Y7
��qq' " 7 i CELL:
CONTRACTOR NAME:
Pr'(1.- Vraj V (-Yf -.1/4- .../—
MAILING ADDRESS: I I "L Q9 0 2. 1l (�/ , ' /J/ L./
1. ,+ ` r (,__,
Cx (�.ii` //`l �' /f+ cs E: 1l ZIP: q4,( `"
PHONE: /Ps 41 /nMO / CELL:
CONTRACTOR LICENSE NO.: �-. (/ R;-- 'lG' G BUSINESS LICENSE NO.� /•
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: / /4. !
'fear Off �� ] Overlay
T•TAL COST OF PROJECT: $
-
DISCLAM ISR
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 r red to be s •mltted and subs qu tly appi ved before this application can be processed.
Signature P de • Date:QL3 r /CO
•
Updated 1-11-11 Page 1 of 1
Received Time Mar. 25. 2016 1 O:43AM0. 31 32arolyn\Downloads\Reroof_doc