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What is the JOB SITE address?
APPLICATION INFORMATION
ASSESSOR'S tax parcel number?
s, p1511 hAl�rll or r iclq
Legal descri ion as it appears on_jhe props deed Q, , I
1. 7- {/
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357
OWNER,or OCCUPANT
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iling address J
Phone
Who should contact regarding this project? 1,
City, state
Zip
z� Wet..v4-' q Qom/
Phone
92-4L 3 ,7jJ
What work is being d e under this permit?
Contractor
Building height
dimensions
# of stories
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:
60
What is the square footage of
the sign face?
How high is the sign?
Year:
9 9�
Make:
Installer
CLA-
Contr ctor
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 Under round
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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Post -it -routing request pad 7664
BRAND
ROUTING - REQUEST
Please
I❑ READ
Li HANDLE
❑ APPROVE
and
❑ FORWARD
II
I
RETURN
KEEP OR DISCARD
❑ REVIEW WITH ME
To
55' 4'oi
Date From
react (boo -1,1
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