2012, 07-27 Permit App: BLD-2012-1201 Tear Off, ReroofCommunity Development Department
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ctPermit Center (Staff Use Only)
l'v of 7T^„ 11703 East Sprague Avenue, Suite B-3
jle Spokane Valley, WA 99206 PERMIT NUMBER:
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Valley
Tel: (509) 688-0036
`•/iQJ Fal: (509) 688-0037 PERMIT FEE:
Perm Rcentertispoka neva I
REROOF CONSTRUCTION PERMIT APPLICATION
El COMMERCIAL ❑ RESIDENTIAL
SITEADDRESS: -InC%S
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
CITY: .SI fl�G%�, F STeTF: yL 14 ZIP: � 72 Cab
PHONE: r-" 9J�2 c�� �� /n FAX: CELL:
CONTACT NAME:
PHONE: SG oz, -e— FAX: _ f� CELL:
CONTRACTOR NAME: /SDC vif= lrLoy f „1V
MAILING ADDRESS: �1 0[ C k ii) h Z t
CITU: &//O �G"r- STATE: LL�iiL ZIP:
PHONE: ,)V 7 -2-1-6- FAX: CELL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
,Tear Off/�ll ElOverlay
TOTAL COST OF PROJECT: 4 ;k'Oo ov
DISCLAIMER
The permitted verlfles, 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
caner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compllance 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��,�nnof a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be req]j40d Lo be submitted and subsequently approved before this application can be processed.
i Page
http://www.spokanevalley.org/filestorage/124/938/210/948/ 1496/Reroof_Permit_ 1-11-1I.doc