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'ROICCr ADDRESS: Ctiola-,i/-
\VNCR X�/1?OX .r - I'1 /f- 1371 _-..r
{AILING ADDRESS:
(street) gy(city/stale) (zip)
.ONTRACrOR- Fn1^ E CEAIT LICexSE: ICM. 1-73 b U:
PHoNE: 9 a to 89 i I
AILING ADDRESS: E. Ci 31 h �;D(_' Aq u P_ c'^r+ 1f A /J r- 1 I I A C)
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meet WSECs mim AFUS rating
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$100
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s100
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6
`NOTE MI1dBnWPER2,9TrFSrS435C0 PLUS: PROCPSSINGFffi 4in-V
OTAL PERMrr PEE Dun Is �i r
SIGNATURE
SPOKANE COUNTY DIVISION OF IIUILDINGS