2015, 03-19 Permit App: BLD-2015-0578 Tear Off, Reroof Project # D oOI5 6 S /
Community Development Department H � )
Permit Center
11703 East Sprague Avenue, Suite B-c
ilC Spokane Valley, WA 99206 PERM A,IB9R20t5
Valle3 Tel: (509) 688-0036
" Fax: (509) 688-0037 PERMIT FEE:
aermitcenter@spokanevallev.orq OCV "CnM!T CCNYCR
REROOF CONSTRUCTION PERM AA►T `IV#
COMMERCIAL RESIDENTIAL
SITE ADDRESS:
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: \(J 1'(
ADDRESS: ,c.5 )(D G - Lf LL j L-t 1
CITY: 6?0,< LN0, L L-U .( STATE: \-P\ ZIP: CActak
PHONE: 253- q.S 1 -4L00) FAX: CELL:
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: l-(� Cbzi- t / vKJ
MAILING ADDRESS: J. I' K.0 02---LC)
.
CITY: STATE: (.)0c)(.)0c) O
ZIp: CI.Ct,
t�
PHONE: Loci - (SS FAX: CELL:
CONTRACTOR LICENSE NO.: COQ GG 7' f EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
`.Tear Off 0 Overlay
TOTAL COST OF PROJECT: $ 400
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 `__ �. G Date: u -l S - 7p iS
Updated 1-11-11 Page 1 of 1
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