2011, 02-14 Permit App: 11000362 Tear Off, Reroof Community Development Department
���f Permit Center (Staff Use Only)
o C OE 11703 East Sprague Avenue, Suite B-3
Ukane Spokane Valley, WA 99206 PERMIT NUMBER: // (73157
Valle Tel: (509) 688-0036
Fax: (509) 688-0037
J oermitcenter@sookanevalley.orq PERMIT FEE: //S. CM
REROOF CONSTRUCTION PERMIT APPLICATION
[l COMMERCIAL 'ESIDENTIAL
SITE ADDRESS: ( 3CQOS" C 6 71!
ASSESSORSPARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: L U /�7
NAME: d LO/) to
ADDRESS: //� ' , J
CITY: //34 Oc" e....-.5- (.O F STATE: W//�' ZIP: C? /6
PHONE: q--7 -3 / q3 FAX: CELL:
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CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: �
MAILING ADDRESS: P&-,z2ChD�` /(®_7t Fi" `)
CITY: <7l/bK_1dl LLC STATE: ZIP:
PHONE: FAX: CELL: •
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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TOTAL COST OF PROJECT: $ �I [tp 3 ,
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 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 required to be submitted and subsequently approved before this application can be processed. J
Signature Date:
c2 -/ 4—//
Updated 1-11-11 Page 1 of 1
http://www.spokaneva l l ey.org/fi lestorage/124/938/210/948/1496/Reroof_Perm it_1-11-11.doc