1991, 10-01 Permit App: 91006374 Re-RoofDate 10/1 /q1
BUILDING PERMIT APPLICATION, BLDG. PERMIT NO.
Jurisdiction of _'S;D nkane Coun i
Applicant to complete numbered spaces only. REC. #
JOB ADDRESS
LOT NO.
ELK TRACT
LEGAL
(❑ SEE ATTACHED SHEET)
1 DESCR.
OWNER
MAIL ADDRESS
ZIP
PHONE
2TL-YY'�L_& Nancy Shatto/E.
14312 - 21 / �6 Veradale,
Via. 99037
/ 922-9070
R
CONTRACTOR
MAIL ADDRESS
PHONE
LICENSE NO.
3 Inland Roofing & Supply
Co. /E. 0 23 S�radue/Scokane
< Wa.
99212/ INLANRS233J4
ARCHITECT OR DESIGNER
MAIL ADDRESS
P ONE
LICENSE NO.
4
ENGINEER
MAIL ADDRESS
PHONE
LICENSE NO
5
LENDER
MAIL ADDRESS
BRANCH
6
USE OF BUILDING
7
8 Class of Work: ❑ NEW ❑ ADDITION ❑ ALTERATION 91 REPAIR ❑ MOVE ❑ REMOVE
9 Describe Work: reroof house
10 Change of Use From
Change of Use To
11 Valuation of Work: $
SPECIAL CONDITIONS:
PLAN CHECK FEE PERMIT FEE 77, r_58
Type of Occupancy
Const. Group Division
Size of Bldg. No. of
(Total) Sq. t. Stories
Max.
Occ. Load
APPLICATION ACCEPTED BY: PLANS CHECKED BY. APPROVED FOR ISSUANCE BY Fire Use Fire Sprinklers
Zone Zone Required ❑ Yes No
OFFSTREET PARKING SPACES:
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
HEATING, VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW
THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES
GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT. THE GRANTING 0 A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY
TO VIOLATE OR CANCELTH VISIONS OF ANY OTHER STATE OR LOCAL LAW
REGU 0NSIRUCTI O PERFORMANCE OF CONSTRUCTION,
XTU'RE
OF CONTRACTOR OR AUTHORIZED AGENT
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
No of
Dwelling Units Covered Uncovered
Special Approvals Required Received Not Required
ZONING
HEALTH DEPT.
FIRE DEPT.
SOIL REPORT
OTHER (Specify)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M. 0. CASH PERMIT VALIDATION CK. M.O. CASH
>.. 7 A & H -MOSES LAKE