2011, 08-01 Permit App: 11002274 Tear Off, Reroof Community Development Department
�n Permit Center (Staff Use Only)
SITY pokane okEast Sprague 99206 Avenue, Suite B-3 Z Z t�J
Spokane Valley,WA 99206 PERMIT NUMBER: I,l/�G� 3—
Oermitcenter@spokanevalley.org Tel: (509) 688-0036
Valleys Fax: (509)
688-0037 spokanevalley.ora PERMIT FEE: I `' J
REROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL IV RESIDENTIAL,
SITE ADDRESS: �/ G �/ /� 14 74/2`
ASSESSORS PARCEL NO.:35e SZ .03( 3 LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: z fJ cr'i 7 ,,2 </7 f l�
ADDRESS: 2 3 D G/ - /i
•
CITY: 1-ld4 49 STATE: ZIP: ;'-,=? 2/L
PHONE: > &q FAX: CELL: cil7g 1//
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: TL A- ,1, L/ft-y nrr/?L/� /c%-, ' /T 37CZ
MAILING ADDRESS: 3V-`/ 9
CITY: 5�v b,, , STATE: � ZIP: l /,2/L
PHONE: FAX: CELL: re / / /
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
l Tear Off fl Overlay
TOTAL COST OF PROJECT: $ /(7j .3C/0 , G�
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 �� Date: /////
Updated 1-11-11 Page 1 of 1
http://www.spoka neva Iley.org/filestorage/124/938/210/948/1496/Reroof_Permit_1-11-11.doc