2016, 03-25 Permit App: BLD-2016-0961 Re-Roof 1 JC/) -: -OUc—O`1r✓
Community Development Department _
Permit Center (Staff Use Onty)----CITY OF �
Spokane
� � East Sprague Avenue, Suite B-3 VE D 13e—,13e—,Spokapoke ne Valley, WA 99206 PERMIT NUMBER:
Tel: (509)Valley Pax: (509) 688 4000
0037 PERMIT FEE:
permitcenter@spokanevalley;o�,
ANTER
REROOF CONSTRUCTION PERMIT APPLICATION
" COMMERCIAL i ES DENTIAL, --C J
SITE ADDRESS: ii O ' 1
ASSESSORS PARCEL NO.: s, LE c A ESCRIPTION:
BUILDING OWNER NAME:r a,.Q_) _ Ci e ,7
NAME: �G .2„, .. 1.� ,1„,/ ' AA ,
./
ADDRESS: /0Q�) 1 � .
CI '� 1 CZ Ata, cal - STATE: / ft—, ZIP: (?9(:)0 7—
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PHONE: qa8--,33 2._ FAX: CELL:
CONTACT NAME:
•
PHONE: FA • CELL:
CONTRACTOR NAME: (/� ra ( _ j ---th LA_Ad )
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MA;LING ADDRESS: ) / 0 0 2. /l A # i_. _/..a
CIf i WI c.4 , . P JAI.. �: ZIP: q- az) ,
PHONE: _IL[ 7l 4 FAX: g ^• ' e�� CELL: '•
CONTRACTOR LICENSE NO.: O, (la66:,.._R-I:6-1)(.2 C BUSINESS LICENSE NO.' `
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: / Ate► z/ k
/ _ i
f�� 1 1
Iv- Tear Off PQ EI •verlay
TOTAL COST OF PROJECT: $ (1°t7, — _ r
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
he served by potable water. .) 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 re ulred to be submitted and sub equ ntly appived before this application can be processed.
Signature . i J J
g LI' / _. / Date: �). L lU
_
Updated 1-11-11 Page 1 of 1
C•UiI=Prc Carolyn\Downloads\Reroof.doc
Received Time Mar. 25, 2016 10:44AM"'No. 3134