1996, 06-17 Permit App: 96004526 ReroofAPPLICATION INFORMATION
What is the JOB SITE address?
S)G S S . Ac's'
ASSESSORS tax parcel number?
Legal description as it appears on the property deed
J
OWNERorOCCUPANT
C 79- iL5
Mailing address
YOS ,s
Phone
g91-1 2-F/
City, state
Sod* 6t.
Zip
Who should we contact regarding this project?
A by
Phone
Y9/—/ 9`1 2
What work is being done under this permit?
Pc kc -tit- TRd Si?..;j
Contractor
WA State Contractor license #
Mailing address
nS S. ,e QC/6/0
Architect/Engineer
What is the heat source?
Building height
Dimensions
93> Ja
# of stories
TOTAL SQUARE F
13/D
Unfinish
2nd floor area
What is t. - coat of your project?
sement area
700
i ed basement area
Size of decks, etc.\
l0x2/fix zo
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.
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