1995, 03-02 Permit App: 95001091 Reroof qc_z--__,-
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APPLICATION INFORMATION 1 O
What is the JOB SITE address? ASSESSOR'S tax parcel number?
g-"/1-"'71/---- Z/S-D ,E' ---S-'- / (0 --Z
Legal description s it appears on the pro/
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OWNEffaeO Phone
Mailing aaddd/dd/ress //// City state n Zip
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Who should we contact regar is pr•'ect7 Phone �j
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What work i -1 • done under this permit? J
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Lone e� Inspector district Property size Right of way width
a) 5,
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Water district
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Building Building height #of stories
Contractor , Dimensions TOTAL SQUARE FOOTAGE
A4fzie_ 7 7''-'-7--2/-'-7-tc- --WA State Contractor license# Main floor area Unfinished basement area
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- ing add -ss 2nd floor area Finished basement area
3 5, R//,e
rchitec Engineer Garage area Size of decks,etc.
What is the heat source? W Zhe colt o` r project?
Manufactured Home Sign l
Width: Length: What is the square footage of How high is the sign?
the sign face?
Year: Make:
Installer Contractor
Wa State Contractor license# We State Contractor license#
Mailing address Mailing address
N.
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.