1996, 08-02 Permit App: 96006152 Family RoomAPPLICATION. INFORMATION
'What is the JOB SITE address? ASSESSOR'S tax parcel number?
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Legal description as it appears on the pro
deed
OWNER or OCCUPAN
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Mailing address cos LU C12 1/4.)I l,es
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Phone
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o26-2202 wh
City, state Zip
SVo i -0-1A _ 1f-- 8420
Who should we contact regarding this project? Phone V V"T (c _ YYlC .j `
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What work is being doe under this permit?
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Building:;,
Building height
# of stories
Contractor
Dimensions
TOTAL SQUARE FOOTAGE
WA State Contractor license #
Main floor area
Unfinished basement area
Mailing address
2nd floor area
Finished basement area
Architect/Engineer
Garage area
Size of decks, etc.
Whet is the heat source?
What is the cost of your project?
Manufactured Home
Sign
Width:
Length:
What is the square footage of
the sign face?
How high is the sign?
Year:
Make:
Installer
Contractor
Wa State Contractor license #
Wa State Contractor license #
Mailing address
Mailing address
Relocation
Fire Safety
Previous address
Fire Sprinkler
Tent
Paint booth _ Fire Alarm _ Fireworks display _
VALUE
Contractor
Contractor
WA State Contractor license*
WA State Contractor license #
Mailing address
Mailing address
Fuel Storage Tanks:
Is*fr: ming Pool;
(Circle one) Above -ground Underground
Contents of tank(s)
Size / gallons
Size / gallons
Private
Public/semi-private
Contractor
Contractor
Wa State Contractor license #
• 'WA State Contractor license #
Mailing address
Mailing address
COMPLETE ALL APPLICABLE INFORMATION
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
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Site Plan
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INCLUDE THE FOLLOWING:
❑ All roadways, driveways & easments
❑ Distances from center of roads, right of ways,
private roads & property lines
❑ All existing & proposed buildings
❑ Underground utilities
❑ North arrow
O Septic tanks & wells