2013, 09-04 Permit App: BLD-2013-1762 Tear Off, Reroof 1
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Community Development Department
Permit Center (Staff Use Only)
CITY
mune11703 East Sprague Avenue, Suite B-3
/ � Spokane Valley,WA 99206 PERMIT NUMBER:
4 i e r
1�f fTel:Fax:(509(509)) 668888-20003367
PERMIT FEE: d ("7-i ,
permitcenterOspokanevallev.orq
REROOF CONSTRUCTION PERMIT APPLICATION
0 COMMERCIAL 6 RESIDENTIAL
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SITE ADDRESS: 13,,7ca - 0771 c/Lif —/� Qd.
ASSESSORS PARCEL NO.: LEGAL DES RIPTION:
BUILDING OWNER NAME:
NAME: �e Q 0 n t‘C L I3G. l(ez. .
ADDRESS: I (> ? (9. lA) , On t we,.(-5--, 7-.-P , cL i ,l C�j q
CITY: 6K61`l-c I 1(t S(� STATE: W ZIP: / r - -o 6
PHONE: ()c / �o lVJ -7 FAX: CELL:
CONTACT NAME:/ ( GC IA.—Q____
PHONE:
-
PHONE: A__ l")0 Q FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS: ' 2- _ P--60 LJ`-'t((��
—
CITY: STATE: ZIP:
PHONE: FAX: ---&---- 22-7)0137--T-7-6—
CONTRACTOR LICENSE No.: EXPIRES: CITY B 1? I4ff#SE NO.:
DESCRIBE THE SCOPf OF WORK IN DETAIL AND INDICATE USE: RECEiVED
EPV42013 �;
Tear Off ❑ ` Over! SV PERMIT CENTER
TOTAL COST OF PROJECT: $ s �/ 5-00,- Oz UD --,;-:,� ���
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 Develo. ent code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley , it is .t a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information m v be require, to be submitted and subsequently approved before this application can be processed. a
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Signat� re .` y
ci — Date: - L') - ) J
Method of pay -n . 0 Cash / Check 0 Visa E Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\02 Administration\03 Forms -Official Versions\Permit Center\Reroof Construction Permit App
10.28.07.doc