1989, 05-23 Permit App: 89001412 PoolSpokane County
DEPARTMENT of BUILDING & SAFETY
A Division of Public Works
INFORMATION WORKSHEET
PARCEL NUMBER:
STREET ADDRESS: J.t7
/'J
CITY/STATE/ZIP: 5/,1 / /y -)tt
SUBDIVISION:
BLOCK: / LOT: yi ZONE: DISTRICT:
LOT AREA: F/A: WIDTH:(, DEPTH: /4'L, / R/W:
# OF BUI
/
OWNER: /))r//e/) Ji )I.ire /
MAILING ADDRESS: (3_57,..c),,
CITY/STATE/ZIP:
PHONE:
l.{gin . l I) /0
CONTACT: Me.
PHONE:
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE:
****************************************************************************
CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
BUILDING INFORMATION
PHONE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS:
REQUIRED PARKING:
X (WIDTH X DEPTH) SQ. FT.:
# HANDICAP: SEWER (Y/N): HYDRANT:
PLUMBING INFORMATION
CONTRACTOR LIC$:
CONTRACTOR:
MAILING ADDRESS:
***************************************************************************
MECHANICAL INFORMATION
CONTRACTOR LIC#:
CONTRACTOR:
MAILING ADDRESS:
ELECTRIC: GAS:
ENERGY CODE: WSEC:
OIL: CCAL:
NWEC:
APPROACH: • PRESCRIPTIVE:
WOOD: SOLAR: HEAT PUMP
UTILITY: SGC:
POINT: COMPONENT: SYSTEMS:
***************************************************************************
MECHANICAL FEES
ITEM DESCRIPTION
PROCESSING FEE
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
GAS HTG EQUIP (iO0, 000)BTU -_
GAS HTG EQUIP +100,000
GAS PIPING - # OF UNITS
HEATPUMP 1-100 BTU
HEATPUMP 101-500 BTU
HEATPUMP 501-1000 BTU
HEATPUMP 1001-1750 BTU
HEATPUMP +1751 BTU
REFRIG 1-100 BTU
REFRIG 101-500 BTU
REFRIG 501-100 BTU
REFRIG 101-1750 BTU
REFRIG +1750 BTU
AIR CONDITIONER 0-3 HP
AIR CONDITIONER 3-15 HP
AIR CONDITIONER 15-30 HP
AIR CONDITIONER 30-50 HP
AIR CONDITIONER +50 HP
VENTILATING FANS
EVAPORATIVE COOLERS
HOODS
CLOTHES DRYER
RANGE
GAS LOG
UNLISTED GAS APPLIANCE
AIR HANDLER 1-10000 CFM
AIR HANDLER 10000 CFM
NUMBER OF_
YES OR NO
PLUMBING FEES
ITEM DESCRIPTION
PROCESSING FEE
TOILETS
SINKS
SHOWERS
BATH TUBS
KITCHEN SINKS
DISHWASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIC WATER HEATERS
FLOOR DRAINS
FLOOR SINKS
BAR SINKS
ROOF DRAINS
LAWN SPRINKLER
SEWAGE EJECTOR
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
NUMBER OF_
YES OR NO
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