2013, 02-06 Permit App BLD-2013-0204 Re-Roof GarageCommunity Development Department
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Spokane `�
ValleSpokane
yREROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL RESIDENTIAL
SITE ADDRESS:Iq� - 1% ,�ASSESSORS PARCEL NO.: �$)� j , a3o� LEGAL DESCRIPTION:
Permit Center (Staff Use Only)
11703 East Sprague Avenue, Suite B-3 Valley, WA 99206 PERMIT NUMBER: 1
Tel: (509) 688-0036 S�x
Fax: (509) 688-0037 PERMIT FEE:
permitcenterC�sgokaneval ley.org
BUILDING OWNER NAME:
NAME:
W-0 —Y0-
J(�
ADDRESS: 1�y�l (%
CITY: J ' STATE: ZIP: 9�V
PHONE: I'' FAX: �� CELL:
CONTACT NAME: A, k) 6'-7
PHONE: FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS: 1,0nLt- E A-4 "l, ._ _l - e r L ,.
CITY: STATE: I ZIP:.
PHONE:
FAX:
CELL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
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TOTAL COST OF PROJECT: $�JZ>d
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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 Developm e. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not' r approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be regyired t b sub d and subsequently approved before this application can be processed.
Sign
Date: Z` I, 1 � -
Updated 1-11-11 Page 1 of 1
http: //www. spoka neva I ley.org/filestorage/124/938/210/948/1496/Reroof_ Permit_1-11-11. doc
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PROFESSIONAL LAND SURVEYORS
619 N. MADEL1A STREET
SPOKANE. WASHINGTON 99202
PHONE 509.926.2821 FAX 509.926.2735
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