1992, 11-09 Permit App: 92009877 RemodelSpokane County
DEPARTMENT OF BUILDINGS
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET
/2/2,/
PARCEL NUMBER:
STREET ADDRESS:
�r
CITY/STATE/ZIP:
SUBDIVISION:
BLOCK: 7:k2 LOT: ZONE: DISTRICT:
LOT AREA:
# OF BUILDINGS:
OWNER: `, j �s
F/A: WIDTH: DEPTH: R/W:
# OF DWELLINGS: WATER DISTRICT:
MAILING ADDRESS:
PHONE:
11 -
CITY/STATE/ZIP:
CONTACT: �jfi�s✓ �/%o/�' ���,�/�
SETBACKS: - FRONT: LEFT:
PERMIT USE:
PHONE:
RIGHT: REAR:
//s
******************************************************************************
CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
BUILDING INFORMATION
PHONE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: REMODEL: X ADDITION: CHANGE OF USE:
DWELL UNITS:
OCCUPANT LOAD: BUILDING HGT: STORIES: 1
BUILDING DIMENSIONS:
REQUIRED PARKING:
X
(WIDTH X DEPTH) SQ. FT.:
# 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.
*******************************************************************************
SQUARE FOOTAGE:
MAIN FLOOR
SECOND FLOOR
BASEMENT - FINISHED
UNFINISHED
GARAGE
CARPORT
DECKS
ADDITIONAL AREAS:
**************************************************************.****************
LENDER/BOND HOLDER:
ADDRESS
CONTACT
PHONE