1995, 11-27 Permit App: 95009853 Safety Inspect0)
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3 APPLICATION'INFORMATION
\/yhat is the JOB SITEaddress?/ o ats� ASSESSOR'S tax pa l number? D
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Legal description as it appears on the property deed p
OWNER or OCCUPANT Phone
—"' na 1(Y)U� 2X (00-1a ?OLIO/Mailing
ad ress City, state - Zip
At t J n w S / Ma 9Q2 LX
190) 8 0
Popco (, j
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Who should we contact regarding this project? Phone
—ref) (L2a iXiem
What work is bone under this permit?
b=erest a.� akt a -P ° Aoki" y� �`�"`�.
map
Zone _ _:- - , -
Inspector distnct
Property size
Right of way Width
Water distnct -- -:
.. ..:..,.:.. ..
Building Building height
_ -- _
# of stories ,t: . ;t?
Contractor bimensions
TOTAL SQUARE FOOYAGt
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.
What is the heat source? Whatt7is the cost of your project?
Home 'l9n
ManufacturedWhat
Length: the square footage of
the sign face?
How high is the sign?
Year:
Make:
Installer Contractor
Wa State Contractor license # We 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-. Swi[nming Pool,_ -
(Circle one) Above -ground Underground
Size / gallons
Private
Contents of tank(s)
.
Size / gallons
Pubtic/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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