1995, 11-15 Permit App: 95009593 ReroofN
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APPLICATION INFORMATION
What is the JOB SITE address? /.
/ 5- !/�/ 1y/�� w Y / Y 4a
Legal description as it appears on the property deed
g y su-e -
ASSESSOR'S tax parcel number?
OWNER or OCCUPANT
Phone
7a Z-
Mailing address
4- 72/.5-- Y✓l
City, state
Zip
Who should we contact regarding this project[?
What work is being done under this permit?
k c r
Phone
Contractor
(DJ,
Building height
Dimensions
# of stories
TOTAL SQUARE FOOTAGE
WA State Contractor license #
Main floor area
Unfinished basement area
Mailing address
'fnd floor area
Architect/Engineer
Garage area
Finished basement area
Size of decks, etc.
What is the heat source?
What is the cot of your/,project?
\)x 0-0c)
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 _
Paint booth Fire Alarm
Tent
Fireworks display
VALUE
Contractor
Contractor
WA State Contractor license #
WA State Contractor license #
Mailing address
Mailing address
Fuel Storage Tanks
Swimming Pool
(Circle one) Above -ground Underground
Contents of tank(s)
Size / gallons
Size / gallons
Private
Public/semi-private
Contractor
Contractor
5
h
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.
Site Plan
INCLUDE THE FOLLOWING:
❑ All roadways, driveways & easments
❑ Distances from center of roads, right of ways,
private roads & property lines
O All existing & proposed buildings
❑ Underground utilities
❑ North arrow
0 Septic tanks & wells