1995, 02-23 Permit App 95000949 Reroofn
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APPLICATION INFORMATION
What is the JOB SITE address? r ASSESSOR'S tax parcel number? r7
Legal description as it appears on the property deed U.�
OWNER or OCCUPANT Phone
44me> Ask
Mailing address City, state Zip
Who shouldwe conte t regarding this project? Phone
C3�� C. MrmEr q g
What work is being done under this permit? ( p
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one
Inspector district
Propertysize
fig o way width
Water district
Building
Building height
# of stories
ContractorDimensions
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IIx, 75 { f
TOTAL SQUAREFOOTAGE
A State Contractor license #
O I+ D- 3 1 L-
Main floor area U
Unfinished basement area
ai ing address
C • 53 c, h
2nd floor area
finished basement area
Architect/Engineer
Garage area
Size of decks, etc.
What is the heat source?
hat is the cost of your project?
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Manufactured Home
Sign
Width:
Length:
What is the square footage of
the sign face?
How high is the sign?
Year:
Make:
Installer
Contractor
Wa State Contractor license #
We 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 atldresa
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
a State Contractor license #
A 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 programa or activities.
Site Plan
INCLUDE THE FOLLOWING
❑ All roadways, driveways & easments ❑ Underground utilities
❑ Distances from center of roads, right of ways, ❑ North arrow
private roads & property lines ❑ Septic tanks & wells
❑ All existing & proposed buildings
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