1995, 11-21 Permit App: 95009764 Reroof ,
APPLICATION INFORMATION ,�•• 7, 4y
'What is the JOB SITE address? lA ASSESSOR'S tax parcel number?
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Legal description as it appears on the property deed
OWNER or OCCUPANT Phone
Mailing address City,state Zip
&°./7 Z
Who should we contact regarding this project? Phone
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What work is being done under this permit?
ns orfdistnct Propertysize Right of way width
Lane
4) 4)
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i N
Water district
Y Y
a
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5, a)
D ! O
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?
q ZSR
Manufactured Home Sign
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
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in,its programs or activities.