2014, 11-14 Permit App: BLD-2014-2770 ReroofCommunity Development Department
— Permit Center
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11703 East Sprague Avenue, Suite B-3
Spokane Valley, 99206
�` 7 ■1eye Tel: (509) 688-00303 6
\.tYf�R■1 Fax: (509) 688-0037
Permitgente, mspokanevalley.ora
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REROOF CONSTRUCTION PERMIT " l IOX--
❑ COMMERCIAL 191RESIDENTIAL
SITE ADDRESS:
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: ^,IY,Cz�f S�. LuFLL�
ADDRESS:nLi)�I [,j . ?) t �,� �1
CM:� //4 STATE: WA ZIP: 7�nb-l—L�A
PHONE: %� p - R I-110 FAX: CELL:
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS: Q1S S. IJJZ�rf
CITY: IVagn 4 Lx STATE: ZIP: 4
PHONE: 5(y4- JA-455t� FAX: CELL:
CONTRACTOR LICENSE NO-t6c(I IM 14, EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
,Tear Off ❑ Overlay
TOTAL COST OF PROTECT:. $
DISCLAIMER
The permitted verifies, acknowledges and agrees by thelr 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 Permlt 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 additlonal
Informatlon may be required to be submitted andl `se�quen\tly approved before this application can be processed.
Signature L �. La. Date: ILL
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