2014, 09-12 Permit App: BLD-2014-2177 Re-RoofSpokane
#Valley•
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
Dermitcenterasookanevallev.om
REROOF CONSTRUCTION PERMIT APPLICATION
® COMMERCIAL r/ RESIDENTIAL
SITE ADDRESS: 6 / 7 �G L. %tf i�'nIU2
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: %urn y •. S111» -m r/41 1 p1 -
ADDRESS: •l / y g/ D F l '7"& .
Cm: ,5 eo-kc o ( 1 CZ L k I4 STATE: (A) A
44
PHONE:
ZIP:
FAX: ciao: •
(19'0 2/7
CONTACT NAME:
PHONE:
FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
Cm:
STATE: ZIP:.
PHONE:
P AX: CELL:
CONTRACTOR LICENSE No.:
E XPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
f
'r( r' of r- GI nor rc r o0 -F rCc,,C/Crl e_ C
,d Tear Off ® Overlay
TOTAL COST OF PROJECT: $ —
j1_
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 o/ this City of Spokane Valley permt Inure to the property owner. 3) The signatory Is the property
owner or has permission to represent the property owner in this transaction. 4) NI construction Is to be done In fug 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 sybratted an g subsequently approved before this application can be processed.
Signature
Date: 1 — /Y
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof Permlt_1-11-11.doc