2013, 08-01 Permit App BLD-2013-1530 Re-Roof08/02/2013 10:16AM FAX
ZIEGLER CENTRAL POLE
d0002/0002
Project #I8
—(3.—! C-.3v
Spokane
Valley.
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
p L nitcenter@spokanevalley.orq
(Staff t1lse Only)
PERMIT NUMBER:
PERMIT,FEE:- ^F
SUB
REROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL
SITE ADDRESS: I \9 E 13ROPebW F '
ASSESSORS PARCEL NO.: 4/ ///, Z ip .. LEGAL DESCRIPTION:
BUILDING OWNER NAME: (jv5 c,a_
NAME: Ro L ) u
ADDRESS: �, S'q iv, L�KEW JcaO b
CITY: 6pe c.k! A Le,.t
PHONE: - G fir^ - G C a O
CONTACT NAME:
FAX:
p RESIDENTIAL
e.AtetrS57 A)G.
STATE:.— t) ZIP: S--$87
CELL:
PHONE:
FAX: CELL:
CONTRACTOR NAME: Zi c e� �,�,,� •
MAILING AopRESS:
CITY: ,S PO ! rJ E STATE: A
PHONE: 5 o / -- Za Lj r
FAX: S-69 gal-, S ZZ CELL:
ZIP: 992I�
c) 3i5-2[43 .
CONTRACTOR LICENSE NO.:Z)eo .,*3Ig.a46 EXPIRES: 4_,p4 (y CITY BUSINESS LICENSE NO.;
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
Ct� Val i09- A.r O
f 1„4 `y3.4..11k..44.1. �.J L1.11A rIY
E Tear Off
TOTAL COST OF PROJECT: $ Inc
Overlay
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 potebie 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 thls transaction. 4) All construction is to be done In full compliance with the City of
Spokane Valiey 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 requires o be submitted and subsequently approved before this application can be processed.
Signatur Date:e03/4 3
Method of payment: L1 Cash
Bankcard #:
Authorized Signature:
❑ Check
Visa
EXP:
D Mastercard
VIN#:
c5r6
Effective October 28, 2007 Page 1 of 1
P:\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Reroof Construction Permit App
10,28.07,doc