2013, 06-03 Permit App: BLD-2013-1013 Re-Roof,y= Community Development Department
Permit Center (Staff Use Only)
Sc�yT�� 11703 East Sprague Avenue, Suite B-3
C Spokane Valley, WA 99206 PERMIT NUMBER:
Valley Tel: (509) 688-0036
'� Fax: (509) 688-0037 PERMIT FEE:
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Dermitcentei-Ospoka neva Iley. org
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL ❑ RESIDENTIAL
SITE ADDRESS:
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: KiJ of S'P�
NAME:
ADDRESS: 06
�L /
CITY: �)
, v STATE: W zIP:
PHONE: CJ�) ",-) � �FAX: CELL:
CONTACT NAME: �� L, �C 4 G--r�kj2
PHONE: FAX: CELL:
CONTRACTOR NAME:`,
MAILING ADDRESS: ?�
CITY: �j�C) �p, ,� STATE: C�C ZIP:.
PHONE: .5' Z51 —01)3 FAX: JZ) I q 6 ��� L( CELL: j - ')'S Q �j ill
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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) 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 per ' or approval r any viola ' n of federal, state or local laws, codes or ordinances. 6) Pians or additional
information may be r quir a submi ed and bsequ approve fore this application can be processed.
Signature Date:
Updated 1-11-11 / Page 1 of 1
http://www.spokanevaIley.org/fIlestorage/ 124/938/210/948/ 1496/Reroof_Permit_1-11-11.doc