1995, 07-20 Permit App: 95005378 Re-RoofY
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APPLICATION INFORMATION
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What is the JOB SITE address? ASSESSOR'S tax parcel number?
Ai, et.LCR At • Poki,J,E wA o N at c
Legal description as it appears on the property deed
OWNER or OCCUPANT
-101114AJ Y --7-3A(6S
Phone
Mailing address
City, state
`f39.1 AIt KC llir/Z 4b P6fz4A16 W,A
Zip
99 / (
Who should we contact regarding this project? Phone
S r CRR4 eo//5TR+d t ick b -P 5PA1 N /A/c, 5/53 -5-5-65/
What work is being done under this permit?
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Building height
# of stories
Contractor
Dimensions
TOTAL SQUARE FOOTAGE
WA State Contractor li nse #
Eg2N.,e.= «31<L
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?, / t S"
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
a State Contractor license #
A 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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