2011, 04-19 Permit App 11000991 Re-RoofCommunity Development Department
�-_'�' Permit Center Staff Use Only)
Scuy of 11703 East Sprague Avenue, Suite B-3 ` Y)
pokane Spokane Valley, WA 99206 PERMIT NUMBER:
jVa11ey Tel: (509)688-0036 i 7j
x Fax: (509) 688-0037 PERMIT FEE: i�
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REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL//�� RESIDENTIAL
SITE ADDRESS: qq6 � L 17
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ASSESSORS PARCEL NO.: LEGAL DE CRIPTION:
BUILDING OWNER NAME: z 1 I V1--
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NAME: Z,iV V� `U- ( VL
ADDRESS: (//]]�l [ C... '✓ //'/U w , //�^--
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CITY: 504 Qyr�s_ . L STATE: &LIA ZIP: 99�2.
PHONE: �j Q q '�7Z�7JJ 0,1 p ( FAX: CELL: 5� 2-70
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CONTACT NAME: �f yyl -
PHONE: FAX: CELL:
CONTRACTOR NAME: iV 1/ 4
MAILING ADDRESS: - -
CITY: STATE: ,ZIP:
PHONE. FAX: CELL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
IXI Tear Off ❑ Overlay
TOTAL COST OF PROJECT: $ Z . 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 requiT54o be submitted an quentVlapproved before this application can be processed. ,
Date: 61Y
Updated 1-11-11
http://www.spokanevalley.org/fiestorage/124/938/210/948/1496/Reroof permit_1-11-11.doc