2013, 08-23 Permit App: BLD-2013-1682 Tear Off, Reroof ' b- 20( 3 - (kik )
Community Development Department
QTY OF10111"\1111114k Permit Center (Staff Use Only)
11703 Sprague East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206 PERMIT NUMBER:
40000 Val\iille Tel: (509)688-0036ttl f
Fax: (509)688-0037 PERMIT FEE: I "�
permitcenter @spokaneval ley.orq
REROOF CONSTRUCTION PERMIT APPLICATION
0 COMMERCIAL RESIDENTIAL
SITE ADDRESS: 131 0 E 1)1-) AN-c-, 4ich,,.c_ it. )1/2. 1.14- 9 of 2) 4,
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDINGIOWNER NAME: 1L c my a y,;l :S Aa r) f cj,J (0
NAME: 6^ a r y y a,kJ J /1 er i,., Cc) t i)
ADDRESS: :� / a O 1 ) / I f \c _
CITY: .-Vo h u Yt. V 41 i ey STATE: w/- ZIP: i `i .2 ) (p
PHONE: �Fi — — E
,1-7 FAX: CELL: r :S0 7-- l - ( y 77
CONTACT NAME: Z-ct ynt Qv y/
PHONE: FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
J. Tear Off ❑ Overlay
TOTAL COST OF PROJECT: $ 3 0 0 V ,
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 to be submitted and subsequently approved before this application can be processed.
Signature `-( , Al--------
Date: X— 2-3 _ 20
Method of payment: 0 Cash ❑ Check 0 Visa 0 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