2014, 05-05 Permit App: BLD-2014-0948 ReroofCrl'Y OF'
s
Spokane
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:
PERMIT FEE:
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL
SITE ADDRESS: 0 16 Ci`
RESIDENTIAL
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ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: —D,Q/I aC�
ADDRESS:
7;1616 rat
bITY: vt jr:. [/4/1
PHONE:
STATE: % 4
FAX: CELL:
ZIP: c9 24? --
50-
- I' -.50g-, 820{- 71`y0
CONTACT NAME:
PHONE:
FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY:
(� L qtr
STATE: ZIP:.
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCORp OF WORK IN DETAIL AN INDICATE USE:
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TOTAL COST OF PROJECT: $ B 0(D „
El Overlay
DISCLAIMER
The permitted verifles, 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 mar be required-tgbe submitted and subsequently approved before thls application can be processed.
Signature
z
Date: ma(/ / ((i
Project # 0144
RECEIVED
MAY 0 5 2014
CSV PERMIT CENTER
Updated 1-11-11 ', RF
http://www.spokanevalley.org/filestorage/124/938/210/948/1496�FFerr000fPor it_I-11-1PgI