2015, 03-25 Permit App: BLD-2015-0636 Tear Off, Reroof F.
�� Community Development Department
crry Permit Center (Staff Use Only)
Spokane 11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206 PERMIT NUMBER:
Valley Tel: (509) 688-0036
'� Fax: (509) 688-0037 PERMIT FEE:
4000
oermitcenterc sookanevalley.orq
REROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL P 2 RESIDENTIAL
SITE ADDRESS: 62.3 S &A o1i1'2 N') eo
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: ` 1w No CA kk 4
NAME: �`01...\\Cick CI (�
ADDRESS: 6 a`J. S. „.sc. NI `-Pm;V) R.1
CITY: .Sbvf VP(1--1— ---(7 STATE: thJ ZIP: cJq6
PHONE: FAX: CELL:
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: 'fiRAQ ( IC. '\PA5S C 0Ns(5-m 1CTI OM
MAILING ADDRESS: dq_ 0 Nni tr< SC
CITY: t,16- STATE: (i,) \- ZIP: q q, 0-7
PHONE: 50`?— 53P..—0055 FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
-x-'12 0 t, Poli 61 R O C-K P39Tt D S, 'E-RoDF
ri Tear Off 1E Overlay
TOTAL COST OF PROJECT: $ -OOO
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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Signature (- pDate: 3 - - (�j
Project 6W--(9-0)S- Cfc36
RECEIVED SPI
MAR 2 5 2015
CSV PERMIT CENTER
Updated 1-11-11 ; I : REV, y I Page 1 of 1
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