1995, 05-05 Permit App: 95003032 Reroof APPLICATION WORKSHEET I1
General Information 1
Job address Parcel number
12619 E 16th 11
Phone '
Owner Kelly Jack
Ma ding address 12619 E 16th
Ltater
City
Spokane Wa 599216 p
ti
Site Information
I
Legal Descnptron
Property size Water Distnct Numberot: Dwellings Buildings
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Project Information ` Valuation $4021.81 Fee $89.46
Permit Use New Addition Remodel Change cot use 1
_ Building Information
Ii
Dwelling units Occupant load Building height t ' Stories
Building dimensions Totat square lootage Keq'dparkng Handicap parking Spnnkler system CntrcalMatenal
r
Square footage breakdown Heating and insulation information (R—valves)
aum arMoor Uncovered/covered deck Heat source
hecond floor Other list ceiling Vaulted ceding Above grade wall
Finished basement Below grade wall Floor Slab on grade
Unfinished basementDoor(u—value) Window Furnace ettsxncy
total window area `lb of lloor area
Garage
• 1
Contractor Information r
Building contractor _Plumbing contractor
Spokane Roofing Co Phone
License number Phone License number
SPOKAR*340L7 838-8633
Mailing address Mailing address
P.O. BOX 3946
City,state,zip City,slate,zip
Spokane Wa 99220-3946
Heating contractor Other/Lender
License number Phone License number Phone
Mailing address Mailing address
City,state,zip City,state,zip
PROJECT CONTACT PHONE
Carol or Barb 838-8633
Spokane County Division of Buildings
1026 West Broadway Ave * Spokane,Wa 99260 * (509) 456-3675