2016, 03-25 Permit App: BLD-2016-0964 Re-Roof ;-,t 001".\111fth Community Development Department
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Permit Center (Staff Use Only)
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11703 Gast Sprague Avenue, Suite 13-3
Spokane Valley, WA 99206 PERMIT NUMBER:
Tel: (509)688-0036
40010.ValleY I
Fax: (509) 688-0037 PERMIT FEE!
p .itcentec_@spokanevalley.orq
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REROOF CONSTRUCTION PE ' MIT APPLICAT N
'd COMMERCIAL C • ESIDE TIAL ‘:fr
SITE ADDRESS: /10 C' a . 4„o
ASSESSORS PARCEL NO.: LEG L D SCRIPTION:
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BUILDING OWNER NAME; /� , , AST
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NAME at ' . , II i i aw/� 1 !' r`�I /
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PHONE: • ` 2 ,. /,� FAX: ` CELL:
CONTACT NAME:
PHONE: c FA CELL:
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CONTRACTOR NAME: i r ,/i V� ---: t4i12 iIv
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MAILING ADDRESS: ) l lia o 2. Fr 1' All IL_! .._
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PHONE: g s 7s 011 a I — . — I Jr CELL:
CONTRACTOR LICENSE NO,:KA, V ( ) . R: .6k& f y/ C r BUSINESS LICENSE NO.'.
DESCRIB vTHE SCOPE , ORK N DET• IL AND I• DICATE USE: f ej//&
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V ear Off i fE I Overlay
TOTAL COST OF PROJECT: $ Loci
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 reaulred to be submitted and subseque by approved before this application can be processed.
Signature ra,e ak,a—KDate: ce/951162
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Updated 1-11-11 Page 1 of 1
C:-\l lcerc\ra rolyn\DOwnloads\Reroaf.doc
Received Time Mar. 25. 2016 10: 56AM No. 3138