2014, 04-09 Permit App: BLD-2014-0705 Tear Off, Reroof Community Development Department
:- `\ �y� Permit Center
CITY OF -' � (Staff Use Only)
Spokane East Sprague Avenue, Suite B 3
Spokane Valley, WA 99206 PERMIT NUMBER:
Valley Tel: (509) 688-0036
do0
Fax: (509) 688-0037 PERMIT FEE:
permitcenter(@spokaneva Ilev.orq
RE ROOF CONSTRUCTION PERMIT APPLICATION
fl COMMERCIAL Ay RESIDENTIAL
SITE ADDRESS: r 0 (00 47 6 271
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: ---j .7 .CZ
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL: •
CONTACT NAME:
PHONE: FAX: CEL :
CONTRACTOR NAME: le- .e 44.E R C
MAILING ADDRESS: •&6 c )._ c.
• (4_7„..,,,( ' .7
CITY: �l F)� ( STATE: 1../0
c . ZIP:. ,6
PHONE: Com-"G G"?J e--D-40 -- S':----)- -7 2 FAX: CELL: •
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
7:1:ear Off o4---- J Overlay
TOTAL COST OF PROJECT: $ 7 gi'62-0
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)Ownershi. • his City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to repreent-thprop-• y ow in this ansaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Developmen de. Refer_ ed ..es ar- - -'able ,,,r review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit i$.- 6t a permi . appr•'al for - y ation . federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be,re(uired to b- bmi -. and -..se. -ntly a..roved before this application can be processed.
Sign it jje°..- Date: — E y4
Project # 5(--P.001(1-6705
- RECEIVED a
APR 0 9 2014
•
CSV PERMIT CENTER
Updated 1-11-11 SUB # , REV. #
Page 1 of 1.
http://www.spokanevalley.org/filestorage/124/938/210/948/149G/R�ieuf ���it_i 11 11.doc