2013, 05-20 Permit App: BLD-2013-0922 Reroof■ e 05/20/2013 9:16AM FAX 97899522
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SPkane
40...Valley
ZIEGLER LUMBER
Community Development Department
Permit Center
11.703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Rax: (509)688-0037
permitcenter@spokanevallev.orq
810001/0001
/3Cfi-ZO(3-O`?z
(Staff Use Only)
PERMIT NUMBER;
PERMIT FEE:
/1(3 75
REROOF CONSTRUCTION PERMIT APPLICATION
0j COMMERCIAL
SITE ADDRESS: g2-7- ^ `62 -Lt tJ. (J i Lbr r
IN RESIDENTIAL
f5Pb
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: 5FP�
BUILDING OWNER NAME:
NAME:
ADDRESS: 'gzi - Z-3 /U. C+ I V
CITY: YoKiei- (/ �f
STATE: (- ZIP: W,
PHONE:
FAX: CELL:
CONTACT NAMF:
PHONE:
FAX: CELL:
CONTRACTOR NAME: Zie4 v_f_ Co
MAILING ADDRESS: ‘243 �r hie) A-it)�
CITY: 5PagA-)je-
PHONE: 5-Q9 q6- quo FAX: a�a� ?
CONTRACTOR LICENSE No.: Z,xEG1LL 3 16563 EXPIRES: f-'3 3 CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
Te6-4 DF le.00F Rh -co v (-11.7-1-/ It LAbt.1SsU TPDi<14/&3
STATE: L'Pt
ZIP:
91Z/ d
CELL: Sb? 305—Z!63
[g Tear Off 0 Overlay
TOTAL COST OF PROJECT: $ 6K1571_--
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that; 1) if this permit is for construction or on a dwelling, the (Telling is/will
be served by potable water, z) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is 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 arc available for review at the City of Spokane valley Permit Center. 5)1 The City of
Spokane Valley permit Is not a permit or approval for any violation of federal, state or local laws, codes or orclInanCes. 6) Plansior additional
information may be Yd to be submitted and subsequently approved before this application can be processed,
Signatu
Method of payment: ❑ ash
Bankcard #;
El Check
`�,Vlsa
EXP:
Date: S Zo -( j
❑ Mastercard`
VIN#;
Authorized Signature: AO ri 5/frer
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