2016, 03-28 Permit App: BLD-2016-0984 Re-Roof 4/54
Project # 7,J . (b "d
Community Development Department
,-- Permit Center
11703 East Sprague Avenue, Suite B-3 (Srtaff used
1414,E D
Sjökane Spokane Valley, WA 99206 PERMIT NUMBA
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Tel: (509) 688-0036 ,, I 1 0
Va11e�� Fax: (509) 688-0037 PERMIT FEE:
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REROOF CONSTRUCTION PERMIT APIP-L.ICATIONW'EV �—
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[] COMMERCIAL
JCI RESIDENTIAL
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SITE ADDRESS: '13 19e • Aoki kvQ • S. D kan4) y`
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ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: �
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BUILDING jkn _ r i OWNER NAME1:, cc
NAME: c c LlIAatono._ v�4 .
ADDRESS: 9C)l01, E , A k1 ,4v
CITY: kax�Q vc�_, STATE: q q ��
1 _ ZIP:
PHONE: 5oa — ,t9'Bp - LI 15 FAX: CELL:
CONTACT NAME: L )ILl[aA t)via ni,p Q-A-o--14
PHONE: .-3;(''I ,- d'3D- _6;15 FAX: CELL:
CONTRACTOR NAME: D U>Y1 o) --
MAILING ADDRESS: l .e, aS (bcJe
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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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.
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SignatureC '
( r;,,j/r (, ,$' Date: '-‘,04001(0
Updated 1-11-11
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