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2011, 01-21 Permit App: 11000109 Tear Off, Reroof . Community Development Department Permit Center (Staff Use Only) ' CITY QN `""� 11703 East Sprague Avenue, Suite B-3 pokane Spokane Valley, WA 99206 PERMIT NUMBER: I H OI o Valley Tel: (509) 688-0036 1 l �S Fax: (509) 688-0037 PERMIT FEE: I u . oermitcenter©sookanevallev.org REROOF CONSTRUCTION PERMIT APPLICATION 0 COMMERCIAL 0 RESIDENTIAL Q � SITE ADDRESS: (,� 1 5 I I 5�dV-- --e-- JV _ ` k ) .c, .. ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: 6b- BUILDING BUILDINGG OWNER NAME: NAME: ..‹.2_,1") 'S.\)f ADDRESS: 49 7 ( F' 1 °4--- Cm: ?l1cCt i"--t.._ OL-41C-c.) STATE: 4 ZIP: /� Z / Z PHONE: 7 ? 9 ZZ 3 jS FAX: CELL: CONTACT NAME: L-C-1•-) �V ko C\ PHONE: FAX: CELL: CONTRACTOR NAME: VA-1.v 2-4a-cage- 'c . MAILING ADDRESS: / CO ZO fj • V e/� 1-9 G .' .cD CITY: 5 i i'-Q_--- VGJ-'t STATE: L_AJ A— ZIP: `l 9 Z/(p PHONE: 5—C 41 ) Cs I 'T * eil yN S FAX: 2„1-/- / / O CELL:ZO V. 7,`J75 -5-5-5-4 ."-- CONTRACTOR LICENSE No.: j ��`[„1 I Z� EXPIRES: CITY BUSINESS LICENSE NO.: DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: J Tear Off 4 111Overlay TOTAL COST OF PROJECT: $ 5O0 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 co are available for review at the City of Spokane Valley Permit Center. 5) The City of Spokane Valley permit is not a perm't or approval r y violation of federal, state or local laws, codes or ordinances. 6) Plans or additional information may be required to be su mitted and bse uently approved before this application can be processed. Signature Date: i Z % ( Updated 1-11-11 Page 1 of 1 http://www.spokaneva Iley.o rg/fi lesto rage/124/938/210/948/1496/Reroof_Perm it_1-11-11.doc