2015, 01-06 Permit App: BLD-2015-0015 Tear Off, Reroof Community0Oevelopment Department
Permit Center . (Staff Use Only)
Sc1TY OF11703 East Sprague Avenue, Suite B-3
pokane Spokane Valley,WA 99206 PERMIT NUMBER:
Valley-
4oTel: (509 00-5.2 VO
Fax: (509)) 688-0037-36 `7dPERMIT FEE:
permitcenteKatspoka nevallev.org
REROOF CONSTRUCTION PE MIT A PLICATION
COMMERCIALrre RESIDENTIALoject - -6,y 6-COLD
SITE ADDRESS: RECEIVE ,
s
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: JAN 0 6 2015
/___
BUILDING OWNER NAME:
NAME: CSV PERMIT CEP'
ADDRESS: S U B -=- 1, ' REV'
CITY: STATE: P:
PHONE: FAX: CELL:
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: GA 1;wE Lo rQu r ottj
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:
i c•-' - ktM10 REPUKE R'—F1l(.
[Tear Off Q 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 requir to be submitted and subsequently approved before this application can be processed.
Signature / AtKV-..._ eb LL/25c-Th Date: 11� I 1
s
Updated 1-11-11 Page 1 of 1
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