2014, 07-02 Permit App: BLD-2014-1552 Reroof Project # Ee P' o(1 (ss
RECEIVED
Community Development Department - .
Permit Center I (Staff Use Only)
SCITY
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POKane11703 East Sprague Avenue, Suitt B-3
Spokane Valley,WA 99206 C .'PER EMI NI1BE k _/ '
Tel: (509) 688-0036
\/i_11ey Fax: (509) 688-0037S UB IrEE•_ -- In
permitcenterCasookanevallev.orq
REROOF CONSTRUCTION PERMIT APPLICATION
0 COMMERCIAL r-:lk;'/R_E_SIDENTIAL
SITE ADDRESS: /3Dc) , /—" a, c-1 oft C Vet Ile(1 (,0 f4 9963-7
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION: JJ
BUILDING OWNER NAME: La../7q-NAME: DaVIs -+ : Jia.:4„l�J 1�
ADDRESS: I 9 6,7 CC { i'7
CITY:\ �(�e '� Jc (,'I, STATE: Lu AZIP: 9 'I 3-7
PHONE: )q') `"I ui / q �6 FAX: CELL:
CONTACT NAME: Dia i La
PHONE: ( 5))C?) 9q/-7 cFAX:) CELL:
CONTRACTOR NAME: T/'/%ada h ko6 Ari
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: L.C)V I ,3�� ti-7 Lic FAX: CELL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
Tear Off 0 Overlay
TOTAL COST OF PROJECT: $ 5 /d 0
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 be submitted and subsequently approved before this application can be processed.
Signature Date:
od of payment: 0 Cash D 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