1995, 06-29 Permit App: 95004777 MH - .. .
APPLICATION INFORMATION
What is the JOB SITE address? i. / ASSESSOR'S tax parcel number?
f?/LJ S. / G: �' //] c,i , 07 /Zd r .,
Legal description ask appears ort he property deed
OWNER or OCCUPANT Phone
om) l'> )- , 7) til r', r / o��.
Mating addresf s e City,state --/ Zip
Who should we contact regarding this"oject? /- ( Phone 1.
c 1 - rTh
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What work is being do - under this permit?
Lone Inspector district Property size Hight of way width
5
Water district
D 0
Building Building height #fs° j #of stories
Contractor Dimensions 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 How high is the sign?
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71
C/f/\ the sign face?
Year: Make:
. ' 6CO211/6,7
Installer Contractor
,1
Wa State Contractor license# Wa State Contractor license#
.7a.e-�2. -u,S'' e.
Mailing address 2/P _ z.o- •! j% Mailing address
4/s5r- L7`;r•e Zt/ , . z -4� ,r
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 Swimming Pool
(Circle one) Above-ground Underground Size/gallons Private
Contents of tank(s) Size/gallons
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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INCLUDE THE FOLLOWING:
❑ All roadways, driveways & easments 0 Underground utilities
❑ Distances from center of roads, right of ways, 0 North arrow
private roads & property lines 0 Septic tanks & wells
❑ All existing & proposed buildings
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