1992, 03-16 Permit App: 92001544 MH Spokane CoUnty
DEPARTMENT OF BUILDING & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET
PARCEL NUMBER: 1'1'Lv7 n l er... t- 1 i; Jc ' h ()EA o �-r1 S
STREET ADDRESS: / F7 2c) 4-^ UG `��' v�� COvr
CITY/STATE/ZIP: (J-1,,e e-.e1Ctc r PS
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
# OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT:
OWNER: PHONE: — C/l<( - ?c 70
MAILING ADDRESS: jT' i ),2 7 et) E. \L i(e.,5L,,,c.j Ccs�✓ �'
CITY/STATE/ZIP: L -ce c'—A a C 16`e), 63
CONTACT: PHONE: — —
SETBACKS: — FRONT: LEFT: RIGHT: REAR:
PERMIT USE:
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BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:
CONTRACTOR: PHONE: — —
MAILING ADDRESS:
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: