2013, 03-11 Permit App: BLD-2013-0390 ReRoofCorl'ununity Development Department
Permit Center (Staff Use Only)
Mane
11703 CAst Sprague Avenue, SuICe B-3Sp, Spokane valley, WA 99206 12mmiT Num RE C.t � � � � 350
' ��� Tel: (509) 688-UU36 fi
`•%sail, x Fax: (509) 688-0037 PERMIT FEE:
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REROOF CONSTRUCTION PERMIT APPLICATION
9 COMMERCIAL X RESIDENTIAL
SITE ADDRESS: I & d�b 3 $T / `�
ASSESSORS PARCEL NO.:
LEGAL DESCRIPTION:
BUILDING OWNER NAME: :L I C)2&a
NAME:
ADDRESS: , `d, ) G 3 15" Q L� ( ,,
CITY: �/ STATE: I-� ZIP: ' 1� a0 LY
PHONE: '• �1 1 FAX: CELL:
CONTACT NAME:
PHONE:
CONTRACTOR NAME:
MAILING ADDRESS:
FAx:
CELL:
Cn-y. PO BNOX 7174 STATE: ZIP:_
E WA
PHONE: FAX: CELL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE.
Tear Offs, Overlay
TOTAL COST OF PR03ECT: $�
DISCLAIMER
The perrnitted verifies, acknowledges and agrees by their signature that: 1) If this permit is for congnictioll 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 her, perrnisslon to represent the property owner in this transaction. 4) All Constructlon Is to be done In full rompllanr,P with the My of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Per mil. Centcr. 5) The Gty of
Spokane Valley perrniL is not a permit or approval for any violation of federal, state or local Idws, codes or ordinances. 6) Plans or additional
Information Irny he required to be submitted and subsequently approved before this applicatlon can be processed.
Signature
Date: 5 /' -6
Updated 1-11-11.
http://www.spokanevalley,orq/filestorage/124/938/210/948/1496/Reroof Permlf_1.-11.-11 _rtoc
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