1995, 02-15 Permit App: 95000792 Remodel4-,
a)
APPLICATION INFORMATION
What is the JOB SITE address?
1/ Sam. 5v/) v/E'/
Legal description as it appears on the property deed
ASSESSOR'S tax parcel number?
OWNER or OCCUPANT
,EGG
Mailing address
Phone
1 i�aa E , c)A1D/ u/ ('Cz.-_
Who should we contact regarding this project?
Mdiv
City, state t�
SOh'AN,E )
) &%
Phone
Zip
,4 2 SSC- /?
What work is being done under this permit?
tn)151-1/A) 7 or . . 1 N7_
Water district !.
Contractor
M 72- 1 CONST? OC7?A
WA State Contractor license #
Building height
# of stories
Dimensions
TOTAL SQUARE FOOTAGE
1- CPD l0 I e lit/
Mailing address
Main floor area
Unfinished basement area
12 S: R4 -A cf-I fteir< !,r/. 5?eocsive.X10
Architect/Engineer
2nd floor area
Garage area
Finished basement area
Size of decks, etc.
What is the heat source?
What is the cost of your project? (� &^^ nn
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
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.
i REGISTERED, AS PROVIDED BY LAW: AS A:
M T 'L CONSTRUCT. ,.
5818 S RANCH PK LN.
SPOKANE WA
SIGNATURE
ISSUED BY DEPA
99206
F LABOR AND INDUSTRIES