2012, 08-02 Permit App: BLD-2012-1243 Tear Off, Reroof Community Development Department GC•�12�
Permit Center (Staff Use Only)
SCITYpokane 11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206 PERMIT NUMBER:
Valley.4. Tel: (509) 688-0036
Fax: (509) 688 0037PERMIT FEE: f O . C
permitcenter@sookanevallev.orq /
REROOF CONSTRUCTION PERMIT APPLICATION
fl COMMERCIAL gt RESIDENTIAL
SITE ADDRESS:
ASSESSORS PARCEL NO.: 5'5.11 3, i zoLEGAL DESCRIPTION: C_:Qtl.r:e .j Ly V+ti: S`+ti
BUILDING OWNER NAME:
NAME: S -k--vloke- , ge1,32r4t.,
ADDRESS: i 1221 J9llej ...z c,1 AJC
CITY: C.�,,.¢,,„ C2 C.'Ne STATE: W A ZIP: 9 9 2-2-
PHONE:
2PHONE: FAX: CELL:
CONTACT NAME: bu cAt..S \0 n\
PHONE: ' 09 - Z(s)3- `-I 333 FAX: CELL:
CONTRACTOR NAME: (-001 j 0-)i\lc - (--\c e 3 Ur
MAILING ADDRESS: PO 8 cvs YE6 S3
1 ^
CITY: f k,,,,�„� ,I STATE: 4-4-)4-1 ZIP: 97 2 2`
PHONE: S 0")- 2 L9 `4 3 3-N3 FAX: CELL:
CONTRACTOR LICENSE NO.: 11 t,,V,:,e J L, jlojE EXPIRES: JI S 1 i CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
Doc +e..ae- a , r• r54.9x+ Z -;► .tom , 30 i b -k14 , 30 yto.r
IZI Tear Off ❑ Overlay
TOTAL COST OF PROJECT: $ Y000
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 - --"--_ Date: 3121/z
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/fi lestorage/124/938/210/948/1496/Reroof_Permit_1-11-11.doc