2015, 03-20 Permit App: BLD-2015-0597 Demo Bldg Community Development Department (Staff Use Only)
Permit Center
SpokaCITY OF
ne -------- 11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER:
s� Spokane Valley, WA 99206
Valley Tel: (509) 688-0036 PERMIT FEE:
Fax: (509) 688-0037
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DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: (' C'I CI C SOO 12.0,.....e_ Ve,\\Q/ (1)a- 99217
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME: Ry,;a,„ Re,\ \
MAILING ADDRESS: Cc 19( 1_ L 2 t4 Q a n
CITY: .�jy_Clr� UO, I `e4 STATE: UJi;1� ZIP: 1 < /2
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CONTACT PERSON NAME: j i�tAs.
PHONE: 5-09. S4-/Z. -',I 3 FAX: CELL:
CONTRACTOR NAME: `l
MAILING ADDRESS:
CITY: STATE:
ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
El Site Plan Provided 0 Notice of Intent #
[} Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
De o l .s cA O l cQ Out- f310P%
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 . "-- Date: 3- 20 •/5—
Project #A_'Lly 16' D_
RECEIVED
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Updated 1-11-11 Page 1 of 1
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