1991, 12-23 Permit App: 91008765 MHSpokane County
DEPARTMENT OF BUILDING & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
PARCEL NUMBER:
INFORMATION WORKSHEET
STREET ADDRESS: / 7 c)-) 2
CITY/STATE/ZIP: ��a WO 770l6'
SUBDIVISION:
BLOCK: LOT: , ZONE: DISTRICT:
LOT AREA:
F/A: WIDTH: �� DEPTH: t/ S- R/W:
# OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT:
OWNER: _ � � PHONE: ($"U - 2322_ - 1-"40
MAILING ADDRESS: pc,
CITY/STATE/ZIP:-y CjzJ2 / �J y`?U / (o
CONTACT:
PHONE:
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE:
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BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
PHONE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
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:
'lease provide the following information for Energy Code compliance:
;pace heating type (check one)
Forced air electric Electric baseboard or wall mount
Forced air gas Heat pump
Flat ceilings R Doors
Vaulted ceilings R_ Windows U
Above grade walls R__Glazing area
Below grade walls R Total floor area
Floor R of heated space_________
Slab on grade R Furnace efficiency rating
Propane
Other:
,lease indicate on your plans: The location of the radon vent, and the location of the vent fan area.
Square footage
/lain floor:
second floor:
3asement - Finished:
Unfinished:
garage:
;arport:
)ecks:
.dditional Areas: