2011, 07-06 Permit App: 11001987 Tear Off, Reroof "�' Community Development Department
Permit Center (Staff Use Only)
SpokaC ON 11703 East Sprague Avenue, Suite B-3 /�C (�
ne Spokane Valley,WA 99206 PERMIT NUMBER: b 1
galley Tel: (509) 688-0036
Fax: (509) 688 8-0037 °\-1-L)-
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permitcenter@spoka nevalley.orq PERMIT FEE:% '2
REROOF CONSTRUCTION PERMIT APPLICATION
0; COMMERCIAL ❑l RESIDENTIAL •
SITE ADDRESS: / 5 g / �� 3 / f
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
• BUILDING OWNER NAME: •
•
NAME: Jerry ,Kt L t
ADDRESS: / '/5� / i /3l 5'11
CITY: ,5e,d/1'
r V;/1/1-// STATE: gIC( ZIP:
5 T 2/7/?PHONE: a 2/7/? ( 1� FAX: CELL: • .
CONTACT NAME: elYd rx 117.43
A_/q f " •
PHONE: SO? A 3't CJ/ 6 L_/ FAX: CELL:
CONTRACTOR NAME: . , .
MAILING ADDRESS: Ilea('/< �Rf .L /-CI i e j
CITY: i'V f, .� �/� / /e Fete//1 . STATE: (4)q .ZIP:. y gQA 6
PHONE: 7 l 3 L/ j FAX: CELL: ...y 0 _01('o y
CONTRACTOR LICENSE No.: ryi/95/7 I1. / PREt XPIRES: ,ia / CITY BUSINESS LICENSE NO.:
DESCRIBE T E SCOPE//OF WORK IN DETAIL AND INDICATE)US • • ,
4.e,D n /To c)3 e I-e/f ./ �� 51i k /Y v/ G�' S41,3 & 3
v
,Tear Off Q Overlay
j
TOTAL COST OF PROJECT: $ 5/ 4/' -'o
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 a.• ."ed before this application can be processed.
Signature Date: ‘ `
1 f'
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Updated 1-11-11 Page 1 of 1
http://www.spoka neva Iley.org/fi lestorage/124/938/210/948/1496/Reroof_Permit_1-11-11.doc