2011, 06-21 Permit App 11001812 ReroofCommunity Development Department
11703 o i s of Permit Center (Staff Use Only)
*60gon/7e� Spokane Valst lley, WA 99206 prague e, Suite 8-3 PERMIT NUMBER:
♦ a11ey
Tel: (509) 688-0036
�" Fax: (509) 688-0037 PERMIT FEE:
Dermitcenter(asookanevallev ora
REROOF CONSTRUCTION PERMIT APPLICATION
❑ COMMERCIAL gRESIDENTIAL
SITE ADDRESS: ��� 1 'F--
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDINGOWNERNAME:
NAME:
ADDRESS: Q 1 ,,
CITY: �yR .QL�
YAC) v>u STATE: �9.'A ZIP \�Z�\ !/
PHONE: S`Qyl�,- K-1 "l FAX: CELL:
CONTACT NAME:
PHONE: 0•`-i l`J ` FAX• CELL
CONTRACTOR NAME:
MAILING ADDRESS:
CITY: STATE.- .ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SC�PE OF WORK IN DETAIL AND INDICAT USE:
OOc�
❑ Tear Off [� Overlay
TOTAL COST OF PROJECT: $ �5d� ' \
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. ) wnershlp of this City of Spokane Valley permit inure to theProperty
owner or has
Permission
to .sent the roe owner. 3) The signatory Is the property
of
Spokane Valley Develo t code. Referenced codes are taval able transaction.
ew at the consCity of Spokane truction is to be dValley Perone in im t Center. The Ch the ity of
Spokane Valley per no a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may b req I d t be submitted and subsequently approved before this application can be processed.
Date: �-O' CA- \
-11
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Remof_Permit_l-11-11.doc Page 1 of