1995, 03-21 Permit App: 95001584 RemodeliNhat is the JOB SITE address?
APPLICATION INFORMATION
• ASSESSORS tax parcel number'?
4/-) .o S R lD .o If i G Gc 1 / / / /
Legal description as it appears on the propedeed
.� .3 Lt -1 0s6.5
OWNER or OCCUPANT
Mailing address City, state
Who should we contact regarding tttis'project?
eN 4/d -b
Phone
`,2 -/air
Zip
Phone
4,)
What work is being done under this permit?
/DS -e
/V
Water dist
nspec or district
Propedy
blight of way width
Contractor / -f-
-F P`t �P-C/1 / �2
WA State Contractor license #
�
DsT c• ogoi z
Mailing address
At J1 c:17 k- i
rchitec /Engineer
/V/Cde-
Yr
What is the heat source?
o,(r5"7"--
Building hhejg)it
ZOO l jj,44 -r--t l (c m
Dimensions
)R 616-(1)
Main floor area
# of stories
TOTAL SQUARE FOOTAGE
Unfinished basement area
2nd floor area
Garage area
What is the cost of your project?
Finished basement area
Size of decks, etc.
Manufactured Home
Sign
Width:
Year:
Length:
What is the square footage of
the sign face?
How high is the sign?
Installer
Make:
Contractor
Wa State Contractor license #
Wa State Contractor license #
Mailing address
Mailing address
Relocation
Fire Safety
Previous address
Contractor
Fire Sprinkler
Paint booth Fire Alarm
Tent
Fireworks display
VALUE
WA State Contractor license #
Mailing address
Contractor
WA State Contractor license #
Mailing address
Fuel Storage Tanks
Swimming Poo
(Circle one) Above -ground
Contents of tank(s)
Contractor
Underground
Size / gallons
Size / gallons
Private
Wa State Contractor license #
Mailing address
Contractor
Public/semi-private
WA State Contractor license #
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.
5)
h
Q
N
Site Plan
r
-Pc/
ss, 140? -7 /lc ,/
(JA3.E
ROAD V` IDT,I I. �
FRO w FLANKING:
co > P�1FNTlS: 6e L )
EEVIEwEC Z
614.
4
9 4
J yr q�HFp Q��ryai
'"Pe#,pe iak4;44
494144
1
1
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
❑ Septic tanks & wells
j`IOly¢aa
Department of Labor & industries
Contractor Registration Section
PO Box 44450
Olympia WA 98504-4450
To
Register name
�: oCoL,,.,.
NoTamo iaa
REGISTRATION VERIFICATION
(206) 956-5226
SCAN 269-5226
FAX (206) 956-5228
From 07 t1Ctn1
Olympia Headquarters
CCAS!G..(Tie Cat9S.Ar_u 3LP
Registration number
Co$7EC ocIDp 1///2-/
Contractor: Your Certificate of Registration will be sent from the Olympia office and
should be received within 2 to 3 weeks. Please keep this record until you receive your
Certificate of Registration.
F625-036-000 registration verification 4-93
Thank you
VIIG 1 'CHI
r
ADDRE
ZONE:
ss,
f?OAD "JiDT11:
FRO JT:
CO ./1111ENT6:
R: `?IEWEC BY
ftAI, .FNG.
lQv
C_NL 41v.iN 411
r
7.3
pNTAT��S/V Q
/c4OA/04/Nnc�c4-i?rikI
0
16'p'91' 4�/S S'OAt
RT