2013, 06-03 Permit App: BLD-2013-1019 Tear Off, Reroof 1- r
To: 15096880037 From: 15099281989 Date: 06/03/13Time: 3:48 PM Page: 01/01
:YA �._. �.�....., 01
.. . t _ !A
LI
1. 7141
C 0 P
Community Development Department 1 1fg 3 C! ,
Permit Center 1 { (Staff u-se Ondy1 i
MI IN ..:*------::-.::;; 11703 East Sprague Avenue,Suite 3-3
apo a Spokane Valley,WA 99206 ' _ t GINr ��.c-11',., , - y • �.. , 1
.: Valley-. Tel: (509)688-0036 � � ��?, �
Fax: (509)688-0037 Pe
-...._- �......_ - 5 8 o
REROOF CONSTRUCTION PERMIT.APPLICATION •o r4 o
V `i O
0 COMMERCIAL F4 RESIDENTIAL
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: (� h.
C c
o c 0-
BUILDING OWNER NAME, V 3 'O
0
CU 0
NAME: Q fl\1j / Y1VIA1-9 .+.• N N
ADDRESS: M`''1O I 1� 1 •A enu,I
o um
STATE: b�` '1 ' ZIP: otqaC e'no w
tarry: �: )2'0110)01.0-1A ,� 3 0
CELL:
PHONE: \ FAX: O u -a
r+ .0 To
NAME: '�S-� aai 3 E0
2 . - 1(V) FAX: CELL: 3 O o
PHONE: C{ '00 . 9
a
CONTRACTOR NAME _
MAILING ADDRESS: .j
C, 11 } STATE: bon Zip: qq2#
GCm: ,fir',;( \,F c
PHONE � .CL�_ I; t � FAX:,<(-)q-(42R -!C)SI CELL: (d- 99,.. .--- el 107
.�CONTRACTOR LICENSE No.:,. j -_ 140 -Es'� f)/A) CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DET?.IL AND INDICATE USE:
&W-614-044
-0y4
__—_- (1\)( °'t- ocQ,i, C LL LA3 t 31:.9i3-, ._
IATear Off ❑ Overlay
IA
COST OF PROJECT: $ (ojn :72 .
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 servedors potablewater. 2) se Ownership ofthis
owner in of this transactValley ion. 4)t inure to the All constructionisto be done 3)erty owner. full complianche e with theis the Coperty
ityof
owner e has permission to rnt code. the ren property
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center, 5) The City of
iSpokane vanformationImaypbe requiredtta o be submitted and subsequentlit or approval For any y approved before this application can be processetion of federal,state or local laws,codes or d. 6) Plans or additional
_..
signature Ilk. '._,,. ._.•� Date: �
__. ..
l� "_,.._. ....
Method of payment: // Cash ` U • eek ❑ Visa 0 MaREDACTED1 REDACTED •
stercard ,
Bankcard *:
'`EDACTE Ext_ IN#,
Authorized Signature: rti_J �,i i�!►ia .?_. ,'i
This document originally contained
contttlentlaf cress card Infuee� r #�• le
•
Effective October 28, 2007 R
�� 0
P:\Community Development\02 AdminisGation.\03 Forms-Official Versions\Perm to 16 ?nd the gi 3 destroyed
10,28.07-doe
- pursuant to SOS DAN GS2014-030.