2013, 08-26 Permit App: BLD-2013-1686 Tear off, Reroof sL6— 2o\ 3— RDS;,
,ha
Community Development Department
Permit Center (Staff Use Only)
sookarie11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206 PERMIT NUMBER:
ValleTal: (509) 688-0036 �_. y Fax: (509) 688-0037c�
permitcenterspokanevalley.orq PERMIT FEE:
It REROOF CONSTRUCTION PERMIT APPLICATION
0 COMMERCIAL VI RESIDENTIAL
SITE ADDRESS: ( L ( , E . C.tt1N C-3Q c7 KCONS(..)0jk e t Lok 9 CZCD
ASSESSORS PARCEL NO.: LEGAL DESCRIPT ON:
BUILDING OWNER NAME:
NAME: ROA
C._G tt0,NM
ADDRESS: ' ( Z (Z E, 30`1"7)
CITY: 1✓'I oLv 1-•c e.Aa \ STATE: V'T ZIP: _`QX
PHONE: —5 9 FAX: CELL:
Project ;,',=',, _ _ _
EF-C
CONTACT NAME: A"`°
F �._ ��
,, . ��� F I
PHONE: FAX: CELL: j
e
CONTRACTOR NAME: AUG 2013
I
C^\i P L f;1
MAILING ADDRESS: (` z . I . > j'j r i L_
CITY: STATE: SUBZIP' r __�_1 I
PHONE: FAX: r ..
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
0 Tear Off 0 Overlay
TOTAL COST OF PROJECT: $ 300OODJ
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 t a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be regvi d to be submitted an, sub quently approved before this application can be processed.
7.
Signature ! 1../f' 6 L,-, Date: , �'/c7:c3-1/
Method of payment: ❑ Cash ❑ Check ❑ Visa ❑ Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\02 Administration\03 Forms- Official Versions\Permit Center\Reroof Construction Permit App
10.28.07.doc