2012, 10-24 Permit App: BLD-2012-1910 Reroof000.
Spokane
Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
Dermitcenter@spoka neva) lev.orcl
REROOF CONSTRUCTION PERMIT APPLICATION
Ei COMMERCIAL / 0 RESIDENTIAL
`7
SITE ADDRESS: 130,2-(0 7,
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME:
ADDRESS:
CITY:
i06„, ct�
130; l: t «d 4/
(/Cv Q STATE:
ZIP: ??,06
?,06
PHONE:
CONTACT NAME:
? C 7
FAX: CELL:
PHONE: � a LJ ig /Je.,.e&io( FAX: CELL:
CONTRACTOR NAME: 7 -i -t /4 c� #o - e
MAILING ADDRESS: /77/ v,
3d X26,6
CITY:
PHONE:
STATE: e \ ZIP:
gl/,-o ,2_3 FAX: 367 G 7rI-6/..ty CELL: J" 6 ?C J ��
CONTRACTOR LICENSE NO. C. //J $7 EXPIRES: `O W/3 CITY BUSINESS LICENSE NO.:
DESCRIBE THE COPE OF WORK IN DETAIL AND DICATE USE:
Tear Off 0 Overlay
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 approv- for any viion of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be requiredttted a fubseapproved this application can be processed.
Signature
Date: d %Lc/ii
Updated 1-11-11
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof_Permit_1-11-11.doc
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