2016, 04-04 Permit App: BLD-2016-1111 ReroofCommunity Development Department
Permit Center
Spokane 11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Valley Tel: (509) 688-0036
�' Fax: (509) 688-0037
permitcenter�spokanevalley.org
REROOF CONSTRUCTION PERMIT
❑ COMMERCIAL
SITE ADDRESS:
Project
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PERMIT NUMB `
PERMIT FEE: '1
RESIDENTIAL
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: T
ADDRESS:
CITY:
PHONE:
FAX:
STATE:
CONTACT NAME: CxJ i �-t' c r`' rn , a 4 — YV 2
CELL:
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PHONE: FAX: CELL: 5/-'T—
CONTRACTOR NAME: C�
MAILING ADDRESS:9,
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CITY: � STATE: ZIP:
PHONE: — FAX: CELL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
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IN DETAIL AND INDICATE USE:
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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 pern}tt 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 tequired to be submitted and subsequently approved before this application can be processed.
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Date: y-1- /
Updated 1-11-11 Page 1 of 1
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