1993, 10-28 Permit App: 93010402 ReroofAPPLICATION WORKSHEET
General Information
Job a ddcess
Ai • 1104.1.01A --
Parcel number
Owner
Mailing
ai ing address
-14/110
-City
Site Information
Stale
11»1 t-/-
1
-Legal Description
Property size
Water District
JnspectOr:, • •
Number of: Dwellings
Roaiwidth-
." . . .. . .
puddings
Project Information
PermAUse
New
Addition
Remodel
Change of use
'--. gat.ROOF
Req'd parking
Handicap parking
Sprinkler system
Cntical Matenal
Building Information
Dwelling units
Occupant load
a
Building height
Stones
/
Building dimensions
Total square lootage
16 Mb
Req'd parking
Handicap parking
Sprinkler system
Cntical Matenal
Square footage breakdown
Main floor
Uncovered /covered deck
Second floor
Other
Finished basement
Floor
Unit inished basement
-Garage
Door (u -value)
Window
Furnace eftioency
Contractor Information
Heating and insulation information (R-valum)
Heat source
Hat ceiling
Vaulted ceding
Above grade wall
Below grade wall
Floor
Slab on grade
Door (u -value)
Window
Furnace eftioency
Total window area
% of floor area
•
0 gi / o
5 4( c bx.)
um , ing contractor
tcense num.one
(-- C-- j ° 9
lcense num • er
Phone
IVf/aii re, address
12!T4. /ere 77/
Mailing address
City, zip stat
.5.- fr•-71 4 101 4 Ji- •
City, state, zip
ii
eat g contractor
Other/Lender
License number
Phone
License nuruber
Phone
a 1 ing 5. .fess
Mailing address
Cily, state, zip
City, state. zip
PROJEG
0
NTACT
PHONE
3
Spokane County Division of Buildings
1026 West Broadway Ave * Spokane, Wa 99260 * (509) 456-3675
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OEPAPTMENT OF
THIS CERTIFIES THAT THELAsoR
,pERSON INDUSTRIES
NAMED HEREON IS REGISTERED AS PROVIDED BY LAW AS A
NUMR
EFT" EC rt4E-:6'
5)9203
SPOArtm.L.,
COVERAGES
DETACH TO DISPLAY CERTIFICATE
STATE OF WASHINGTON
_F625-052-000(3-92)
xv-vvecwwwomew,,
MM/DD/YY)
14-93
N ONLY AND
S CERTIFICATE
ORDED BY THE
. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED iv iR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER ISPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJcCT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
co
ILTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DD/YY) DATE (MM/DD/YY)
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
X
CLAIMS MADE OCCUR, NEW
OWNER'S & CONTRACTOR'S PROT.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
LIMITS
__—
GENERAL AGGREGATE $ 300,000
09-14-93 09-14-94 PRODUCTS-COMP/OPASG. $ 300,000
PERSONAL & ADV. INJURY $ 300,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER
TATAQuTvnmnm TYPDAPTMPMT OF LABOT
EACH OCCURRENCE $ 300,000
FIRE DAMAGE (Any one fire) $
MED. EXPENSE (Any one person) $
COMBINED SINGLE
LIMIT
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
EACH OCCURRENCE
AGGREGATE $
STATUTORY LIMITS
EACH ACCIDENT
DISEASE—POLICY LIMIT
DISEASE—EACH EMPLOYEE $
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE