195, 03-29 Permit App: 95001848 Re-Roofa)
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APPLICAT4ON INFORMATION
What is the JOB SITE address?
T 7E1, Z,•.,7
Legal description as it appears on the props deed
• ASSESSOR'S tax parcel number?
OWNER or OCCUPANT41(a/76/////
Phone
2/_
Mailing address
Who should we contact regarding this project?
City, state
/7e (//
/ ��%
Phone
3 27— g67'g
Zip
What work is being done under this permit?
Inspector district
Water district
Contractor
Building height
Dimensions
# of stories
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.
What 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
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
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.