2010, 10-04 Permit App: 10003229 Reroof114.e\
1Valley
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(o sookanevalley.or0
(Staff Use Only) ���J
PERMIT NUMBER: , ,ZZ• C\
PERMIT FEE: 8* \ l 115
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL ® RESIDENTIAL
SITE ADDRESS: 13111 E. 5th Spokane Valley WA 99216
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: Seth Bullock
NAME: Seth Bullock
ADDREss:13111 E 5th
CITY: Spokane Valley
STATE: WA
ZIP: 9 ci Z 16o
PHONE:
FAX: CELL:
CONTACT NAME: Action Construction
PHONE:
FAX: CELL:
CONTRACTOR NAME: Action Construction
MAILING ADDRESS: 10109 E 24th Ave
C1ef: Spokane Valley
PHONE: CC (61- -- g 1 FAX:
CONTRACTOR LICENSE NO.: ACTIOC*924CJ
STATE: WA /
50 y / '- 9 •Zry C 33 CELL:
ZIP:
4'12 G
EXPIRES: 6/1/2012
CITY BUSINESS LICENSE NO.: 662"--/q6;-
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
Overlay 1062sf of roof and install new metal fascia.
Overlay 1062sf of roof and install new metal fascia.
❑ Tear Off
TOTAL COST OF PROJECT:
`0O
Q Overlay
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 . - . a permit or approvfor any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
informatio ay be require be su((mitte. . . subsequently approved before this application can be processed.
Signature %v Date: k ( 1(,)
Method of payment: ❑ Cash ja.Check ❑ Visa ❑ Mastercard
Bankcard #:
EXP: 6/1/2012 VIN#:
Authorized Signature:
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