2012, 01-05 Permit App: 12000034 Tear Off, Reroof Community Development Department
" ' ,..,- '"' .. . Permit Center (Staff Use Onl
CITY OF 11703 East Sprague Avenue,Suite B-3
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Spokane Spokane Valley, WA 99206 PERMIT NUMBER: I - 3
Valley Tel: (509) 688-0036 4 l r ( '/75
Fax: (509) 688-0037 PERMIT FEE:
41
oermitcenter@spokanevallev.org
REROOF CONSTRUCTION PERMIT APPLICATION
LI COMMERCIAL )3 S 1 cj--- j1 `RESIDENTIAL
SITE ADDRESS: ( 02 / 6772-
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: 1 ,_ b t4-5
NAME: D/N 1 e �( �It.5)-04
ADDRESS: /3 J c 61 T4 ,5 TA S N('''
CITY: 5po !M N E (1)1.-11Y STATE: vik ZIP:
PHONE: .C 4?
f 'c-.4 4 l ! '7 FAX: CELL:
CONTACT NAME: �-/I fit e .
PHONE: FAX: CELL:
CONTRACTOR NAME: Y '5 ri0 14 c )/ i fi/ .
' MAILING ADDRESS: ,. Q
CITY: C_0 ec)/ �°t?/n'ri •� STATE: 4-1.1A ZIP: 33+/ �f
PHONE: ao- e),1 2 / 7 5 FAX: - CELL: '
CONTRACTOR LICENSE NO.: 1L,$1.5 el()Liu EXPIRES: i/`s- `fie 43 CITY BUSINESS LICENSE NO.:
D CRIBE THE SCQPE OF WORK I DETAIL AND I D�ICATE USE:
Tear Off 0 El Overlay
TOTAL COST OF PROJECT: $ 'IUC)d`
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 submittQd and subsequently approved before this application can be processed.
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Signature Date: i -5`— 4)...,_
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Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Reroof Permit_1-11-11.doc