1992, 06-02 Permit App: 92003911 Remodel Spokane County
BUILDINGDEPARTMENT OF & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 4564675
INFORMATION WORKSHEET
. / PARCEL NUMBER:
STREET ADDRESS:
CITY/STATE/ZIP: -c 0 /1-.(/c; .O
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
# OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT:
OWNER: AW. r /A2 i)% PHONE:
MAILING ADDRESS:
CITY/STATE/ZIP:
CONTACT: PHONE: —
SETBACKS: — FRONT: LEFT: RIGHT: REAR:_
PERMIT USE: o.c,e-e/1 /A// 47,- A /
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BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER: rI ,& S in e a a /L-
CONTRACTOR: 49. •s /77,aiot,7; .f- CG4'57v . PHONE: Sj 7`7 -- frr5 - 5-0 3
MAILING ADDRESS:Rcr x c'7a S .e. -' .c'c-> et//u. _ j�:�0 - 7 a
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:
M t
Please provide the following information for Energy Code compliance:
Space heating type(check one) •
Forced air electric Electric baseboard or wall mount Propane
Forced air gas Heat pump Other:
Flat ceilings R Doors U
Vaulted ceilings R Windows U
Above grade walls R Glazing area `/o:
Below grade walls R Total floor area
Floor R of heated space
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:
PLUMBING PERMIT APPLICATION FORM
Irprmarion Worksheet
r R.
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER: ._..
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) - (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
TOILETS x 6.00 =
x6
6.00 =
SHOWERS x 6.00 =
x6
.00 =
KITCHEN SINKS / x 6.00 =
x6
6.00 =
GARBAGE DISPOSAL x 6.00 =
x6
.00 =
UTILITY SINKS x 6.00 =
x60
6.00 =
FLOOR DRAINS x 6.00 =
x6
.00 = —
BAR SINKS x 6.00 =
x6.00 0 =
LAWN SPRINKLER– FOR EACH BACKFLOW DEVICE x 6.00 =
x6
.00 =
WATER SOFTENER x 6.00 = _
UR NAG
..... ...... ... ..... .... .... ..... .... ..... .:::::::.:.::.:..
x6
00 =
DRINKING FOUNTAIN x 6.00 = _
SUBTOTAL _$
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _$
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675