2013, 09-03 Permit App BLD-2013-1728 Roof Overlay09/03/2013 9:03AM FAX
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Community
Permit Ce
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Spokane V
Development uepartment
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Sprague Avenue, Suite B-3
[ley, WA 99206
(Staff Use Only)
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PERMIT NuMBER:JJil7��'� J'
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Valley
Tel: (509)
Fax: (509)
88-0036
88-0037
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PERMIT FEE: j Vl
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REROOF CONSTRUCTION
PERMIT APPLICATION
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SITE
COMMERCIAL
ADDRESS: 1'5.531 G (a kill+
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, RESIDENTIAL c ect 4
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ASSESSORS PARCEL NO.:
LEGAL DESCRIPTION:
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BUILDING OWNER NAME: ev 1-_,,_
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NAME:
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ADDRESS:
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CITY:
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STATE: ZIR:.
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PHONE:
FAX: CELL:
CONTACT NAME:
PHONE:
FAX: CELL:
CONTRACTOR NAME: ZreyLA.4,,Ler
Co, y",` 6rer.r
MAILING ADDRESS: Lzo 6- /�1>GLAND
CITY: 61)l)-AJC
STATE: (J,3(1 ZIP: 3 zi a
PHONE:
FAX: 007 70, . Z?___ CELL: 5g5--Zj L—e)
CONTRACTOR LICENSE NO.: ?xEN.Uk 3 (a-
EXPIRES 4Q/3 /r CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL
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AND INDICATE USE:
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TOTAL COST OF PROJECT: $ %
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DISCLAIMER
The permitted verifies, acknowledges and agrees by their
be served by potable water. 2) ownership of this City of
owner or has permission to represent the property owner i
Spokane Valley Development code. Referenced codes a
Spokane Valley permit is not a permlt or approval for any
Information may he required to be submitted and subsequ
Signature
Ignature that; 1) it [NS permit is for construction or an a dwelling, the dwelling is/will
pokane Valley permit inure to the property owner. 3) The signatory is the property
i this transaction. 4) All construction Is to be done In full compliance with the City of
available for review at the City of Spokane Valley Permit Center. 5) The City of
violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
ntly approved beFore this application can be processed.
Date:
Method of payment: IN Cash 0 Ch
Bankcard #:
ck ,L�J Visa
EX •
■
Mastercard
VIN#:
Authorized Signature:
Effective October 28, 2007
Page 1 of 1
P:\Community Development\02 Administration\O$ Forms - Official Versions\Permit Center\Reroof Construction Permit App
10.28.07.doc