1993, 11-09 Permit App: 93010895 Fire Damage RepairAPPLICATION WORKSHEET
General Information 1
Parcelnumber
Job address
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Site Information
Legal Descnpt ion
Property size
Water Distnct
Number of: Dwellings
Inspector::
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Project Information
Permit Use
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Building Information
Dwelling units
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Fel
Addition
Buildings
Remodel
X
Change o[ use
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Occupant load
Building height
Budding dimensions
'fotalsquare tootage
Req'd parking
Handicap parking
Stones
Sprinkler system
Cntical Matenal
1
Square footage breakdown
ain floor
Uncovered /covered deck
Second floor
Other
Finished basement
Floor
Unfinished basement
Door (u—value)
Garage
Furnace ell
Contractor Information
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Heating and insulation information (R—values)
Heat source
Hat ceiling
Vaulted ceding
Above grade wall
Below grade wall
Floor
Slab on grade
-Kent"
Door (u—value)
Window
Furnace ell
total window area
1
% of floor area
Budding contractor 1 r
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Plumbing contractor
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License number
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'Phone
` 27-4410
License number
Phone
Man mg a dress ]
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Mailing address
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City, state, zip
Other / Lender
Phone
Hcatng�contractor
License number
Phone
License number
Mailing address
Marling address
City, state, zip
City, state, zip
PROJECT CONTACT
PI-IONE
Spokane County Division of Buildings
1026 West Broadway Ave * Spokane, Wa 99260 * (509) 456-3675
PROVIDED BY LAW AS Ai;
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"EXPIP.ATIDIi.DATE
.11.1.14/1.1
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1804 8ROADUAY
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SIGNATURE
IS$WED BY DEPARTMENT OF LABOR AND INDUSTRIES