2012, 07-17 Permit App: BLD-2012-1125 ReroofCommunity Development Department
Permit Center (Staff Use Only)
Oiy Ut 11703 East Sprague Avenue, Suite B-3 S
polSane Spokane Valley, VIA 99206 PERMIT NUMBER: - 7 Z )
�V 7�ey Tel: 688-0036 75
VFax: (509) 688-0037 PERMIT FEE:
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REROOF CONSTRUCTION PERMIT APPLICATION
FI COMMERCIAL RESIDENTIAL
SITE ADDRESS:ASSESSORS PARCEL PARCELNO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: �,�,�� l -v 4'Clo. anti E-tt�-'-'Ea:,%4d5=y"l
NAME:
CITY: _'y3C Y_e: �l ��(����C�,� STATE: t�' ZIP: air D- .i -
PHONE: Sri `,-r���-��r{O FAX: CELL:
CONTACT NAME:
PHONE: - -) -4j . ) c, �k, Fax: CELL:
CONTRACTORNAME:
MAILING ADDRESS: l� �X V
CITY: STATE: ZIP:
LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
Tear Off ❑ Overlay
TOTAL COST OF PROJECT: Sk-
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature Mat 1) if this permit Is for construction brain 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.
Signature K C, Date: A,
I Page i of 1
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