1995, 06-01 Permit App: 95003838 Reroof ),--t
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s ? U APPLICATION INFORMATION
What is the JOB SITE address? ASSESSOR'S tax parcel number?
Legal description as it appears on the property deed
OWNER or OCCUPANT Phone
3,42 a /A L - PiJ iz J.s eizg 04'
Mailing address , City,state G� Zip
2�1 Ci 'S• i t.vl r3 c12-4.- J� p,2 v/t" V L 2s�D:4 c c IA-I 1 Qo 3 7
Who should we contact regarding this project? Phone
/14,4-,e Dom. j J 28 6 4 R
What work is being done under this permit?
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;i:ar<.;:: Building height #of stories
TOTAL SQUARE FOOTAGE
dOniracior
Dimensions
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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 9
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 Safet
Y
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
uei Sfi�orag Tanks Swimming Poot
(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.