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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 b _ 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/ �`` ! �e tat alb . �K i ParceINumber '�, Lot 1 Block Plat Number �.� / �- t 1(0 5 pprttrrent Fifs Nc)rnbers AiiZone Comp.Plan Census Tract '':'!''''''''r'''':':1;::::4:; :12'4 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 \ � � 0 s CO Numberof Bedrooms w 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` -