1995, 06-29 Permit App: 95004751 Pool 5
-7 5
q l APPLICATION INFORMATION
What is the JOB SITE address? 1 ASSESSORS tax parcel number?
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Legal description as it appears on the property deed
OWNER or OCCUPANT Phone
M?/1/ ,u — e?v4/7-2Ei — 90R61:
as
Mailing address City,state Zip
3 9.Jc/, –(4)4-
Who should we contact regarding this project? r Phone
,37 • g e Y
What ork is being done under this permit?
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Lone Inspector dtstnct; Property;$¢e . . Night of way width
Water district
Q
height Bu�ldmg Building g #of stories
i
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 Signi
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
R•elocation Fire Safety
Previous address Fire Sprinkler _ Tent
Paint booth_ Fire Alarm _ Fireworks display _
VALUE
Contractor Contractor
WA State Contractor license# WA State Cont • ce •
Mailing address Mailing -•dress
Fuel Storage Tanks "wimming Poo}
(Circle one) Above-ground Underground e/gallon g,j Private
Contents of tank(s) Size/gallons --ad. () l \
Public/semi-private
Contractor Co ctor
/7�S
Wa State Contractor license# WA State Contractor license# Sq/1)4 p 6 /1/
Mailing address Mailing address
.2o x 53/3 ,.�C Gia 9eAO3
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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