1995, 05-04 Permit App: 95002970 Reroof APPLICATION INFORMATION _ l
'-----What is the JOB SITE address? / ASSESSOR'S tax parcel number?
Legal description as it appears on the property deed (
OWNER or 9C UPANT Phone
Mailing address City,state Zip
016 fc
Who should we contact regarding this project? Phone
What work is beingdone under this permit?
.. L) l+ 1 CGt-i
�� Lone Inspector distract i-property size R[ght of way width
4-,
ai
Water district
a ,
r
D D
m
�� Building Building height #of stories
.... J...............................:..............................
Contractor � Dimensions TOTAL SQUARE FOOTAGE
` �
(. )c0 C0,C
WA Stat or 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
Width: Length: What is the square footage of How high is the sign?
the sign face?
Year: Make:
Installer Contractor
Wa State Contractor license# Wa State Contractor license#
Mailing address Mailing address
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.