2012, 08-21 Permit App: BLD-2012-1390 Reroof ao' . .'
*, �� Community Development Department
�` crTyOr p Permit Center (Staff Use Only)
Spokane 11703 East Sprague Avenue, Suite B-3 /� _
Spokane Valley,WA 99206 PERMIT NUMBER: 01d—IG—13 D
Valley. Tel: (509) 688-0036 ��
Fax: (509) 688-0037 PERMIT FEE: 411
permitcenter( spokanevallev.org
REROOF CONSTRUCTION PERMIT APPLICATION
0 COMMERCIAL 0RESIDENTIAL •
SITE ADDRESS: 1 Z l 07 F, 2
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: JOSIA_ /-
ADDRESS: 124/07 t-.. 2‘7`A- .
CITY: 5 ,kQ.rte UQ C7 STATE: ZIP: q/z/
PHONE: 509— q._�7t' FAX: CELL:
. /
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: a .
MAILING ADDRESS:
CITY: STATE: ,ZIP:• .
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
•
DES RIBE♦TaH t SCOPE OF WORK IN DETAIL AND INDICATE USE:
,Tear Off 0 Overlay
TOTAL COST OF PROJECT: $ ZF 7 S5 / 7
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 .- submitted and subsequently a..roved before this application can be processed.
Signature Arli � � Date:
/2/ Z
%I
Updated 1-11-11 Page 1 of 1
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