1995, 06-09 Permit App: 95004108 Reroof1
APPLICATION INFORMATION
‘What is th/ �JOB SITE`address?� � � � �� � ��� ASSESSOR'S tax parcel number?
Ll
Legal description as it appears on the property deed
(I S-cilog
OWNER or OCCUPANT
Chov-e(rt� Pv�
Mailing address
3 6)
Who should we contact regarding this project?'
Phone
/1(City, uiiAc, Cv
vie) -e
Phone
Zip
ff44 p
What work is being done under this ermit? pO,c, fc "00
Contractor
Lcwi-el 5110x-► p ('6 iv6,p Hae-4/NLS
WA State Contractor license # /
pt/ l 7/ /1//1
Mailing address
Arch t/7 �v T e lir Ji, R(4) ' .,14 e. ),
no )1
Building height
'imensions
# of stories
Fc,->c3L/
Main floor area
1U i
EFEEer2E r ►T
4J 7210 MELVILLE RD
CHENEY WA 99004
SIGNATURE
ISSUED BY DEPARTMENT OF LABOR AN H4DUSTRIES