1992, 09-15 Permit App: 92007630 Roof, ChimneySpokane County,
DEPARTMENT OF BUILDINGS
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
PARCEL NUMBER:
INFORMATION WORKSHEET
STREET ADDRESS: „,(1 O 04,4e
CITY/STATE/ZIP: cc �,/)/4,{ a,/4407,
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A:
WIDTH: DEPTH: R/W:
# OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT:
OWNER:
MAILING ADDRESS:
CITY/STATE/ZIP:
CONTACT:
PHONE:
PHONE:
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE:
4 5a4
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BUILDING INFORMATION t
CONTRACTOR LICENSE NUMBER: 1 q
CONTRACTOR: ,_ - _ S , CO if 3 PHONE: SP, -
MAILING ADDRESS: `13 Mc C i
ARCHITECT/ENGINEER: AJ(? 0n ,-Q PHONE: - -
•
MAILING ADDRESS:
NEW: REMODEL: X ADDITION: CHANGE OF USE: -i
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 DOORS U
VAULTED CEILINGS R WINDOWS U
ABOVE GRADE WALLS R GLAZING AREA %
BELOW GRADE WALLS R TOTAL FLOOR AREA OF HEATED SPACE:
FLOOR R
SLAB ON GRADE R FURNACE EFFICIENCY RATING
PLEASE INDICATE ON YOUR PLANS:
The location of the radon vent, and the location of the vent fan area.
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SQUARE FOOTAGE:
MAIN FLOOR
SECOND FLOOR
BASEMENT - FINISHED
UNFINISHED
GARAGE
CARPORT
DECKS
ADDITIONAL AREAS:
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LENDER/BOND HOLDER:
ADDRESS
CONTACT PHONE