2013, 08-19 Permit App: BLD-2013-1633 Tear Off, Reroof b-b - '44\3 - f(533
Community Development Department
Permit Center (Staff Use Only)
Sc lne 11703 East Sprague Avenue, Suite B-3
Spokane Valley,WA 99206 PERMIT NUMBER:
Tel: (509) 688-0036
Fax: ( PERMIT FEE:
.00,0vaiky permitcenter509) 688@ sooka0037nevallev.orq
REROOF CONSTRUCTION PERMIT APPLICATION
0 COMMERCIAL [' RESIDENTIAL
SITE ADDRESS: IDI h S 14Lieple
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: erce,,, Fc“...(-f-
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: ke i +3 Zoo
MAILING ADDRESS: �90- /UU S7— /--62-x; bl
CITY: p(O,S1 (Gu((S STATE: T 0ZIP: O <JL
2 "(
PHONE: 0 t3 B ( b t/ LI 2_ FAX: CELL:
J
CONTRACTOR LICENSE No.: EXPIRES: I I - (3 CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK rI DETAIL AND INDICATE USE:
f c• i k clvv._r - r:v P+ aLcL (if1.4 1�1i, C( (V w k i its /e-.S
VI Tear Off ❑' Overlay
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TOTAL COST OF PROJECT: $ b 700
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 submitte and subsequently�seapproved before this application can be processed.
Signature -- -341—t ' �, auG— Date: c ' / i 2
Me Visa ❑ Mastercard
._ _ - • • VIN#:
P .,1�...c Sinzatura• ".........„---1
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