2011, 09-29 Permit App: 11003073 ReroofSpokane
Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spokanevallev.orq
(Staff Use Only)
PERMIT NUMBER: 1 1 736 7 3
PERMIT FEE: 87 ' 37rX
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL
SITE ADDRESS: /T'62
ASSESSORS PARCEL NO.: G/SZ 11,1 got./ LEGAL DESCRIPTION:
SIDENTIAL
BUILDING OWNER NAME:
NAME:
ADDRESS:
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CITY:
V ��i STATE:
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PHONE: r %Q VO` f FAX:
(` ` t CELL:
CONTACT NAME: R;( f\ Nrd
PHONE:7) 6 / / FAX: CELL:
CONTRACTOR NAME: �hAte f
MAILING ADDRESS: E/17/•5%. /?
CITY: a+9/c4
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FAX/2
CONTRACTOR LICENSE No.: A �/(�j OfyIngEXPIRES:
PHONE:
STATE: r3
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CELL:
ZIP: ?17e/6
CITY BUSINESS LICENSE NO.:
DESCRIBE THE SORE OF W IN ETAIL �ND INDICATE USE:
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,,Tar Off
❑ Overlay
TOTAL COST OF PROJECT: $
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 thls 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 Taws, codes or ordinances. 6) Plans or additional
information may be required to be submitted and subsequently approved beforeis2application can be processed.
Signature
Date:
Updated 1-11-11
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http://www.spokanevalley.org/fi lestorage/ 124/938/210/948/1496/Reroof_perm it_1-11-11. doc