1995, 03-21 Permit App: 95001600 MH/06
APPLICATION WORKSHEET
General Information
Owner
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Mailing address
city
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Picone
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Site Information
Legal Description
Property size
Water Distnct
Number ot: -Dwellings
Buildings
t
Project Information
Penmt UseNew
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Main floor
Addition
Remodel
Change of use
Building Information
Dwelling unitsi
Main floor
Uncovered / covered deck
Occupant load
Other
Building height
Stories /
Building dimensions
L)
,
/
VL
T otal square [Dotage 16,o
6 O D
Total window area
7
Zteq'd parking
Handicap parking
Sprinkler system
Cntical Matenat
Square footage breakdown
Main floor
Uncovered / covered deck
Second floor
Other
Finished basement
Floor
Unfinished basement
,
Garage
1
Furnace etticency
Contractor Information
Heating and insulation information (R -values) `
Heat source l
Hat ceiling
Vaulted ceiling
Above grade waU
Below grade wall
Floor
Slab on grade
Door (u -value)
Window
Furnace etticency
Total window area
7
'90 of Floor area 1
ltui(diag confraeto
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Phone
Plumbing contractor
License number
Phone
License number
Maduig address_
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Mailing address
t:ity, s zi
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City, state, zip
Heating • ntractor
Other/ Leader
License number
Phone
License number
Phone
Mailing address
Mailing address
City, state, zip
City, state, zip
PROJECT CONTACT
PHONE
Spokane County Division of Buildings
1026 West Broadway Ave * Spokane, Wa 99260 * (509) 456-3675