1988, 02-09 Permit App: 88000271 Reroof (THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET 88 ��1
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Q
COMPLETE IN INK �� � ��
0-4
(Please return this originalSHADED andAREAS your buildARer
Eing plans to
DEPARTthe DepartmentMENTALUSE of Buildi g and S. e y Q
FOR w
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Owner's Name LAST FIRST MI i �'
Tsalaky John . �� . —d
Project Address(Street Name&Number) Zip
2014 S. Whipple 2c) Spokane Wa. 99206
Applicant Address
River City Roofing, Inc.
Phone P. 0. Box A
City State Zip
Spokane Wa. 99207-0217 (509 ) 483-9160
Business Phone
( )
Contractor/Agent Address
Same
City State ' Zip Phone
( )
Contact License Number(Required) /b_/i/1188 Business Pho e
Myrna James RIVERCR171KS ( D09 ) 483-9160
Architect/Engineer Address
NA
City State Zip Phone
( )
Contact Business Phone
•
( )
Lender NA Address
City State Zip Phone
( )
Res. / Comm.
, ping &- re—raof t/
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ParceINumber '�, Lot 1 Block
Plat Number
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pprttrrent Fifs Nc)rnbers AiiZone Comp.Plan Census Tract
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Numbs of[)welling f tnits Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
tSetbactci .— l Left Setback Right Setback Rear Setback R/W Width
tions, s
:� Square Footage
0
Q a � cc
\
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s CO Numberof Bedrooms
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T.ch Date Group Type
t
DEPARTMENTAL REVIEW
Cond.
ApprovedApproval Hold
Environmental Health Application M
❑ W.1101 College
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
0 N.811 Jefferson
Plan Review/Fire Prevention
❑ N.811 Jefferson
Other(SEPA/Critical Material/etc.)
❑
❑ Fast Track/Special inspection information
Project Representative Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
ya--791-,--/-1 Date - /" Ye
Signature` -