1992, 08-17 Permit App: 92006468 PoolSpokane County
DEPARTMENT OF BUILDINGS
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET
PARCEL NUMBER:
STREET ADDRESS: O a 61,
CITY/STATE/ZIP:f Q y t �'ra�v� r
SUBDIVISION: '1 GAdvto/-Po,A
BLOCK: LOT: 4g� ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
,if OF BUILDINGS: I OF DWELLINGS: WATER DISTRICT:
OWNER: d 'f- Ato Ys c- h PHONE :r -,y, - r Lam` ;F t
MAILING ADDRESS:
CITY/STATE/ZIP:
CONTACT:
PHONE: - -
SETBACKS: - FRONT:rjJ LEFT: kbt RIGHT: REAR:
PERMIT USE:
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BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER: POP (AP -7-170 8-149
CONTRACTOR: PHONE: - -
MAILING ADDRESS:
ARCHITECT/ENGINEER:
MAILING ADDRESS:
PHONE:
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:
PLEASE PROVIDE THE FOLLOWING INFORMATION FOR ENERGY CODE COMPLIANCE:
SPACE HEATING TYPE (Check One)
FORCED AIR ELECTRIC ELECTRIC BASEBOARD OR WALL MOUNT
FORCED AIR GAS HEAT PUMP
PROPANE OTHER:
FLAT CEILINGS R
VAULTED CEILINGS R
ABOVE GRADE WALLS R
BELOW GRADE WALLS R
FLOOR R
SLAB ON GRADE R
DOORS U
WINDOWS U
GLAZING AREA $
TOTAL FLOOR AREA OF HEATED SPACE:
FURNACE EFFICIENCY RATING
PLEASE INDICATE ON YOUR PLANS:
The location of the radon vent, and the location of the vent fan area.
SQUARE FOOTAGE:
MAIN FLOOR
SECOND FLOOR
BASEMENT - FINISHED
UNFINISHED
GARAGE
CARPORT
DECKS
ADDITIONAL AREAS:
LENDER/BOND HOLDER:
ADDRESS
CONTACT
'�- - "; I!
RIJG-17-'92 15:33 ID:HEALTH SIPO TEL NO: 945:32243 #13113 pol
fiUG-14- 11 34 1D. -DEPT OF BUILDINSI TEL r,Jo: 509-456-4703
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