1995, 07-11 Permit App: 95005112 Reroof •
APPLICATION INFORMATION L/5r23c . 2 3"
7kWhat is the JOB SITE address? ASSESSOR'S tax parcel number?
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Legal description as it appears on the property deed
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OWNER or OCCUPANT Phone
QVAAN t):kIL+ l I1 1/o2,66-,-d&-1,e 1.0 J _ 99637
Mailing address City,state Zip
Who should we contact regarding this project? Phone
What work is being done under this permit?
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tone Inspector dlstr t Property size Right of way; idth
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Water district
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Building Building height #of stories
Contractor Dimensions TOTAL SQUARE FOOTAGE
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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 S� rt
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 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
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