2013, 09-17 Permit App: BLD-2013-1882 Tear Off, Reroof Pf3
Community Development Department "� _ aS1)---'
�,r Permit Center (Staff Use Only)
SCITYoKane 11703 East Sprague Avenue, Suite B-3
Spokane Valley,WA 99206 PERMIT NUMBER:
ValleydO Tel: (509) 6813 00 ��Q—5,:Z yo
Fax: (509) 688 0037
permitcenter(a�spokaneva3 I lev.orq PERMIT FEE:
REROOF CONSTRUCTION PERMIT APPLICATION
al COMMERCIAL E RESIDENTIAL
SITE ADDRESS:
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: •
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NAME: P 1 1✓) �b c.-6 i�tL Ij .
ADDRESS: E l y 2- i 2 7-4 Ct •
CITY: 51)140 n4 U6:)IJ ✓ STATE: WA ZIP: I /13
PHONE: (5 J4J)1 tj 7.�.- 7j )JJ FAX: CELL:
CONTACT NAME: l 44 )/S J. I&) - .
PHONE: (5'"7) ,WI `3).fJ2._ FAX: /� CELL:
CONTRACTOR NAME: -- cc! J[ - o der 1 bii i A.r
' MAILING ADDRESS: 6 I lj).--11 2:2, - I ))�// / iCITY: SpS 0�/4 1/4/40
y�k� STATE: W*S h ilt, ZIP:. �J %G�
J
33-
PHONE: / S t'! / �4-j ' 3 J S FAX: • CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
•
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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I Tear Off L Overlay
TOTAL COST OF PROJECT: $ 2. 0145
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 required to b ubmitted and subs uently approved before this application can be processed.
Signature
j Date: 4� — /7:)...04 �_.r� ,r..,-
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E CSV PERMIT CENTER
Updated 1-11-11 • Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof Permit_1-11-11.doc