2014, 06-20 Permit App: BLD-2014-1447 Re-Roof*. Community De%wtopm"t Department
Permit Center
*Wm
;000 ^11703 East Spragu; Avfsni&eSuite B-3 (Staff USQ Only)
a Spokane Valley, WA 99206 PERmrr NUMBER:
Valley Tel: (509) 688-0036
ti Fax: (509) 686-0037
ermitcen ter@spokanevailey,o rbc
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL RESIDENTIAL
SITE ADDRESS: 1� vi E. a Yt�- /4 LJt _ S�0 /tv
ASSESSORS PARCEL NO.:LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAHE: 1 i7i �'l l P 1� 7"�Y ! 1 t L_( / VVI 1 /', ,—I-
CITY:
STATE:
Zra-
PHONE: FAX: CELL:
CONTACT NAME:
PHONE: P33 FAX:f pe_S:2 �10 CELL:
CONTRACTOR NAME: VY I nw� r i� (....G �:.o .) rj n —t—,- _
MAILINGADDREESS:
CITY: �ti/ l�r�STATE: '%q' ZIP:
PHONE: ' 7 /� FAX: V
5, 7� CELL:
CONTRACTOR LICENSE No.: EXPIRES: ZoAz�i� CITY Business LICENSE NO.:
DESCR E THE SCOPE OF WORK I ETAIL AND INDICATE USE:
0 Tear Off ❑ Overlay
TOTAL COST OF PROJECT: $
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) An 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: �ZD
Updated 1-11-11 Page 1 of 1
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