2011, 05-17 Permit App: 11001370 Tear Off, Reroof •
Community Development Department
.. ., Permit Center (Staff Use Only)
SpUkCITY aYle 11703 East Sprague Avenue, Suite B-3 _
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Spokane Valley,WA 99206 PERMIT NUMBER: 47/
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Valley. Tel: (509) 688-0036 ///7;)'
Fax: (509) 688-0037 PERMIT FEE: '$
permitcenter@spoka nevalley.orci
REROOF CONSTRUCTION PERMIT APPLICATION
Q COMMERCIAL / / RESIDENTIAL
SITE ADDRESS: i 30 l (,/ /s 2 -fitASSESSORS PAREL NO.: l LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: pti/i) L�o .4)/�/�'`ADDRESS: / Q / _ _ 67 A/
CITY: 0 L t ' , / /k-- - STATE: ,a/4----- ZIP: 9
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4,175---_- 17, --)
PHONE: FAX: CELL: —,
CONTACT NAME: t4,[. C// Li
PHONE: FAX: CELL:
CONTRACTOR NAME: k,,,a,4 , (,,,,,,,,,,,e/o/i/Oi,o4,„ ,/U c
MAILING ADDRESS: fit 0/ /5,"1/ 36 4 7
CITY: .6 // !//LA 4(' STATE: .ZIP::' / � d
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PHONE: ////'g 3q `- 5'.5(
e FAX: 1. ?J/ --721/ CELL: 9 3 C�,' 767?CCC/// /
CONTRACTOR LICENSE No.: l6f��,��C �I E 'I CITY BUSINESS LICENSE NO.:
DESCRIBE T E COPE OF WORK IN DETA L AND INDICATE USE:
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Tear Off LI Overlay
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TOTAL COST OF PROJECT: $ 6 / 7 ,G__ & U
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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) Owner- ip of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to represen e property owner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Development cod- Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a it or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required t. - s..mitted and subsequently approved before this application can be processed.
Signature /7' --__Date: P,e(// /7/ f//
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof Permit_1-11-11.doc