2012, 04-12 Permit App: BLD-2012-0370 Reroof Apr. 12. 2012 3: 02PM InCyte Pathology No. 9641 P. 2
Community Development Department 202 — 71
p Permit Center (Staff Use Only)c•
fr. •: .::,,..
11703 East Sprague Avenue, Suite B-3
• Spokane Valley,WA 99206 PERMIT NUMBER:
• Fax ((50)688-0037 PERMIT FEED lir ?3•
Fermitcenterc spokanevalley,orq
REROOF CONSTRUCTION PERMIT APPLICATION
II COMMERCIAL ® RESIDENTIAL
SITE ADDRESS: 12409 E 20TH AVE SPOKANE VALLEY, WA 99216
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: TIFFANY AND JOE NELSON
•
NAME:TIFFANY NELSON
ADDRESS:12409 E 20TH AVE
CITY: SPOKANE VALLEY STATE-WA zw:99216
',Hopi!: 9493519428 FAX: ceLL:
CONTACT NAME: TIFFANY NELSON
PHONE: 9493519428 _ FAX: CELL:
CONTRACTOR NAME: TIFFANY NELSON _
MAILING ADDRESS:
12409E 20TH AVE
CITY: SPOKANE VALLEY STATE: WA zip: 99216
PHONE: 9493519428 FAX: CELL:
CONTRACTOR LICENSE NO,: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
RE-ROOFING 3/4 OF OUR EXSISTING ROOF.
RE-ROOFING 3/4 OF OUR EXSISTING ROOF.
•
LP, Tear Off ill Overlay
TOTAL COST OF PROJECT: $ 2000
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 constn.ictlon 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: 4/12/2012
Method of payment: 0 Cash 0 Check ❑ Visa ❑� Mastercard
Bankcard it: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
o:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\aeroof Construction Permit App
10.28.07.doc
Received Time Apr. 12. 2012 2:48PM No, 7161