2013, 05-20 Permit App: BLD-2013-0931 Tear Off, Reroof Community Development Department
Permit Center (Staff Use Only)
SCITY 11703 East Sprague Avenue, Suite B-3 �/
ol�ane410"\ISpokane Valley,WA 99206 PERMIT NUMBER: 6 td ! 3 S
Valley Tel: (509) 688-0036 (J c 1 / .75-4//�y
Fax: (509) 688-0037 PERMIT FEE: 1
permitcenter(@spokaneva Ilev.orq
REROOF CONSTRUCTION PERMI APPLICATION
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® COMMERCIAL . RESI ENTIAL
SITE ADDRESS: / (OO / " 'J 111 / W 4`1 I
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: VAY 2 0 201
BUILDING OWNER NAME: I •
I M CSV PERMIT ( ER
NAME: tbt q"V / " `i f(f SUB °w i EVRECEIVE:
ADDRESS: 1 r O0 '' e cJ 44!€y '.-UL_.—.____.._
CITY: SO of.. 4r. i (1'Z7 1 STATE: (�4 ZIp: ? Z I
PHONE: ( - 9,6 -10a$a FAX: CELL:
CONTACT NAME: g i?j 4,J /11 r -'4r Z
PHONE: SV J - ci 96 - C.2 FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS: t
CITY: STATE: . .ZIP:.
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE scgpg OF WORK IN DETApL AND INDICATE USE:
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iirTear Off0 Overlay
TOTAL COST OF PROJECT: $ 3 cda
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.
Signature -----R4...-N— ifir-7/ Date:
S"- zs-0-/3
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof Permit_1-11-11.doc