2011, 06-07 Permit App: 11001629 Tear Off, Reroof .. Community Development Department
..1. Permit Center (Staff Use Only)
SCom" Wu ✓� ```''- 11703 East Sprague Avenue, Suite B-3 /r 77
°Kane Spokane Valley, WA 99206 PERMIT NUMBE : -77.10y��
Tel. (509) 688-0036 1? 5
4.0°Valley Fax: (509) 688-0037 PERMIT FEE:
permitcenter@spokanevalley.orq
REROOF CONSTRUCTION PERMIT APPLICATION
]' COMMERCIAL ENTIAL
SITE ADDRESS: i! aa . (. . /
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAMEQ
' Q 'er ç'c'\ark S
ADDRESS: v •f caa a Z `-, ll'-- (_A)
CITY: Sed krN c (}k14 STATE: LA,A ZIP: 9 q O�
PHONE: SO Cf_ 97/ FAX: CELL:
CONTACT NAME: /�„/Lc
PHONE: ✓✓'I FAX: CELL:
CONTRACTOR NAME: ( Aat�\-n'v QST 2Ofrf\Fj-
• MAILING ADDRESS: C/v COI./ �.
n �� fir'
CITY: c,2/ - STATE: / j ZIP: / 3e-/y.
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PHONE: "V 7�� >Z5 2-.. FAX: CELL: c9,Tr.., (60— r 3?
CONTRACTOR LICENSE/ No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBErTHE S OPE OF WORK IN DETAIL AND INDICATE USE:
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Tear
6d —Tear Off ❑ Overlay
TOTAL COST OF PROJECT: $ ( ôO
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 a.. - . _ -ny violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be .• itted and subs-.uently approved before this application can be processed.
Signature ' - / _ Date: ��. - 7— ,20//
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof_Permit_1-11-11.doc