2013, 06-25 Permit App: BLD-2013-1204 Reroof •
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• ' 11703 East Sprague Avenue,Suite B-3
.: Spokane Valley,WA 99206 PERMIT NUMBER:
.. • :•••••••:. PERMIT FEE.Tel: (509)688-0036 ��.��
• • Fax (509)688-0037
• •• permitcenter@sookanevallex.orq
REROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL RESIDENTIAL
SITE ADDRESS: 0rd.-3 9- 6
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
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NAME: u p. CO 0 rn
ADDRESS: in
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STATE!. ZIP: 2 C7;CITY: 30.,
FAX: CELL: Y
PHONE: c ce eco
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CONTACT NAME: 'a a.. r.
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PHONES co
FAX: CELL? i c
CONTRACTOR NAME: �I. a
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MAILING ADDRESS: v L,0 [ ' y(C�}n/ U
y p STATE: G l6 ZIP: ). L w
FAX r ` 7,- CELL: 'p 3
PHONE: y Q- � O c -G
e-/‘A/4 CITY BUSINESS LICENSE NO..: 73
CONTRACTOR LICENSE NO.:t7/�/Jj /�� _ /L 6' EXPIRES: C s c
3 'ao
DESCRIBE THE SCOPE OF WORK IN DETAIL. AND INDICATE USE: a,E c 'c M
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TOTAL.COST OF PROJECT: $
3660
DISCLAIMER
The permitted verifies,acknowledges and agrees by their signature than 1)if this permit is for construction or on a dwelling,the dwel@ng 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 requl be submitted and subsequently approved before this application can be processed.
SignatureDate:_19‘ O'5----t3
Method of payment: ❑Cash ❑check isa 0 Mastercard REDACTED
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Bankcard #: REDACTED EXP: REDACTED vIN#:
Authorized Signature: i.-------.
Page lofl
Effective October 28,2007 •
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