2013, 04-24 Permit App: BLD-2013-0720 Tear Off, Reroof Community Development Department
Permit Center (Staff Use Only)
CITY OE 11703 East Sprague Avenue, Suite B-3
pol�ane Spokane Valley,WA 99206 PERMIT NUMBER:
Valley. Tel: (509) 688-0036
Fax: (509) 688-0037 PERMIT FEE: XY
permitcenter@spokaneva Ilev.orq
REROOF CONSTRUCTION PERMIT APPLICATION
ill COMMERCIAL rii RESIDENTIAL
SITE ADDRESS: G'to"( 1 ( I -,-., -
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION Project # 3 td H 3- 7z0
BUILDING OWNER NAME: p,,rer‘ S Rert40.AS I L_ RECEIVED
NAME: C�,,){, APR 2 4 2013
ADDRESS: 6 'O 7 )
V ' -MIT CENTER
CITY: STATE: ZIP:
PHONE: FAX: S UCE L i---, 1
REV.. -# L 1
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CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: ithr,1"k,5( �r-,,,_ ,C t L,C.}1 , &J
MAILING ADDRESS: / 7 07 AJ e •%-iC J,r- V.).
CITY: Cp 091,40.4_, STATE:WM •
ZIP:. J00
PHONE: 50 5 L ? 9 - 355 FAX: 16 t, 3/-/ CELL: )0.` J 0)lv
CONTRACTOR LICENSE No.:hz_rac 9 S7/1 P` EXPIRES: 7 ;/j CITY BUSINESS LICENSE NO.:
DESCRIBETHESCOPE OF WORK IN DETAILQ/ AN INDICATE USE:
% 2�-r (ii ►C E_ Cvc
2:;--'
` Tear Off J Overlay
TOTAL COST OF PROJECT: $ �?';
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/uto be submitted and subsequently approved before this application can be processed.
Signature /� Date: q 1 >3
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Updated 1-11-11 Page 1 of 1
http://www.spokaneva Iley.o rg/fi lestorage/124/938/210/948/1496/Reroof_Perm it_1-11-11.doc