2012, 09-17 Permit App: BLD-2012-1599 Reroof R -
Community Development Department
etrrc �ne Permit Center (Staff Use OnIY)
11703 East Sprague Avenue, Suite B-3
Spokane Valley,WA 99206 PERMIT NUMBER:
.Valley TFax:el: (509(509))688-0036688 0037 PERMIT FEE:
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REROOF CONSTRUCTION PE MIT APPLICATION
COMMERCIAL I (�u, 2.14 �7k RESIDENTIAL
SITE ADDRESS:1jPpvekeu.'111911 1.('i
ASSESSORS PARCEL NO.: 1. . U LEGAL DESCRIPTION: 6]m' -
BUILDING OWNER NAME: I
NAME: CT \LQVtir
Li ADDRESS: ' \D 5 S . AY\S Q b0.0 T
CITY: 0 � ncic \- STATE: ZIP: 9 163-1
31
PHONE: 5D9 "►`2.Z —LLAb FAX: CELL:
CONTACT NAME: \\`\N\ 1,\AN r£
PHONE: FAX: CELL: of tLe I-i-13cn
CONTRACTOR NAME: (../..S k•) __,V.‘
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
0
Tear Off Overlay
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TOTAL COST OF PROTECT: $ 00 A
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 re uired to be submitted and subsequently approved bef e this application can be processed.
t~ , aSignature4 .?,,-k71,27_41/, '7A Date: 2---/1
Method of payment: ❑ Cash g Check 0 Visa 0 Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Reroof Construction Permit App
10.28.07.doc