1992, 09-10 Permit App: 92007435 ChimneySpokane County
DEPARTMENT OF BUILDINGS
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
%RCEL NUMBER:
INFORMATION WORKSHEET
GREET ADDRESS: 5 - c , a vn n o ro.
CTY/STATE/ZIP: V .r-xciatP./ NFL / gG 3-7
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
OF BUILDINGS:
# OF DWELLINGS: WATER DISTRICT:
+1NER: 5W H n
kILING ADDRESS:
CTY/STATE/ZIP :
)NTACT:
5 • 1eQ(0 Fcnc,rc
PHONE: 5c)1 — qa8 — 0 7 g
Ve.rapcc(P,, yvA I el 9037
PHONE: c -)q -9,98 - 07 Q Q
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PMIT USE:
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)NTRACTOR LICENSE NUMBER:
)NTRACTOR:
kILING ADDRESS:
BUILDING INFORMATION
PHONE:
tCHITECT/ENGINEER: PHONE:
kILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
?ELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
JILDING DIMENSIONS:
X (WIDTH X DEPTH) SQ. FT.:
SQUIRED PARKING: # 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.
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SQUARE FOOTAGE:
MAIN FLOOR
SECOND FLOOR
BASEMENT - FINISHED
UNFINISHED
GARAGE
CARPORT
DECKS
ADDITIONAL AREAS:
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LENDER/BOND HOLDER:
ADDRESS
CONTACT PHONE