2015, 05-26 Permit App: BLD-2015-1193 Demo Chimney Prc�jecr �' - _ 7
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Community Development Department (5a ff Use Only)
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Permit Center y� 26 2015
Spol�;ane 11703 East Sprague Avenue, Suite B-3 PERMIT NUM
Spokane Valley,WA 99206
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l: (509) 720-5240 PERMIT FEE: CCENTERr�Fax: (509) 688-0037 G ER N�y I'
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DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: --1g ( 0 E +In A U e
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME: THE HOLY LAoy ,:DF icAZAN RA 5IAk; ell4t?-cH
MAILING ADDRESS: z1 20 k, `v G C +k A V -e j
CITY: S 1 o c�.-In-e V .J € y STATE: W A ZIP: /�}� C/ 9 2 12.
CONTACT PERSON NAME: 0 . 'J l , 4- 1r I ( D�^l v(i P a s t K J yr
0% -75--c-2.
PHONE: tj 7 — c 'f 0 -!5 2. FAX: CELL: S O4' - 5-q0 - 753-2
CONTRACTOR NAME: 0 `'('A!EK
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch))
Site Plan ProvidedL Notice of Intent #
0 Spokane County Utilities has approved the disconnection
Describe the scope iof work in detaile
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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 ubsequently approved before this application can be processed.
Signature ri % , \ Date: S - 2 6 - 15
Updated 1-11-11 Page 1 of 1
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