1995, 03-21 Permit App: 95001599 MH5)7
APPLICATION WORKSHEET
General Information
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Job address
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Owner
e tt'er-
Maihngaddress 6
City
11 Vee -v &CU es
Site Information
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ary LEIIk n lie-fi t
endo mat(
Phone l 2 A ^ gt
State
ZIP
.71016
Legal Descnption
Property size
Water Distnct
tLC'pP ti
Numberot: Dwellings
oad:width
................
Buildings
Project Information
106 7�
EJ_
PenPermit Use
NiatAtal .
kb 1.4-.5(4t elX
Y
New
Total square tootage
Addition
Remodel
Change of use
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7
Building Information
Dwelling units
Occupant toad
Budding height
Stones
Building dimensions) (6 6
Total square tootage
Keq'd parking
Handicap parking
Sprinkler system
CnticaI Matenal
Square footage breakdown
ain floor
Uncovered /covered deck
Second floor
Other
Finished basement
Floor
Unfinished basement
,
Garage
Furnace eflcency
Contractor Information
Heating and insulation information (R—values)
Heat source
Plat ceiling
Vaulted ceiling
Above grade wall
Below grade wall
Floor
Slab on grade
Door (u—value)
Window
Furnace eflcency
rotaI window area
% of floor area
Budding contractor , i ij j
Tit\t/l I- to 'LA 5
Plumbing contractor
License number Y Phone
License number
Phone
Mailing address
F5"'_20 5 ratstAe
Mailing address
City, state, zip
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City, state, zip
Heating contract
Other / Lender
License number Phone
License number
Phone
Mailing address
Mailing address
City, state, zip
1
City, state, zip
PROJECT CONTACT
PHONE
Spokane County Division of Buildings
1026 West Broadway Ave * Spokane, Wa 99260 * (509) 456-3675