1991, 10-01 Permit App: 91006405 SewerSpokane -County
DEPARTMENT OF BUILDING & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
PARCEL NUMBER:
STREET ADDRESS:
CITY/STATE/ZIP:
INFORMATION WORKSHEET
1/,7/7 Lac vs
ge/rda4- c,✓
SUBDIVISION: / (SL - 1 D-� 0p
ro &J
BLOCK: a LOT: / J ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
# OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT:
eryi
OWNER: ,Sa ✓74 Z.
MAILING ADDRESS: 4/ 2 /( 1.. a G ri Sf
PHONE:
CITY/STATE/ZIP: 6 /"7/t4✓'. L.✓&
CONTACT:
Gt.) /(, /Fay Com,
PHONE: 5'a9 -.qZV- 5-3 2)
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE:
BUILDING INFORMATION
r
CONTRACTOR LICENSE NUMBER: te)j < L T i C 1 2% PG
CONTRACTOR: Lc) / h i Ray C a, -1.f - / PHONE: S?— 52z6— fl 2 ,3
MAILING ADDRESS: ,[i oX 3 o/y C. Cv tciq /t LJ t 9 y0 3 2
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.:
REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL: