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1991, 03-19 Permit App: 91001182 Repair Fire Damage Spokane County DEPARTMENT OF BUILDING & SAFETY West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 INFORMATION WORKSHEET PARCEL NUMBER: STREET ADDRESS: ,E I �Q? CITY/STATE/ZIP: eA -.70,4 ,e. SUBDIVISION: BLOCK: LOT: ZONE: DISTRICT: LOT AREA: F/A: WIDTH: DEPTH: R/W: # OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT: OWNER: E ? �) v E.� PHONE: - 1 - )36. MAILING ADDRESS: CITY/STATE/ZIP: CONTACT: PHONE: - - SETBACKS: - FRONT: LEFT: RIGHT: REAR: • • PERMIT USE: -Q� '. �? , -.I . 1 /1 �,!♦ .- ..:: . • fir' I BUILDING INFORMATION• CONTRACTOR LICENSE.*.NUMBER: /77 TA CPO Pkv' . /9 /'(DG{J... CONTRACTOR: TL - (,o/V5 7?f}C%//a) PHONE: MAILING ADDRESS: Sr 366 . �['�Q/t- )> S P //v ARCHITECT/ENGINEER: PHONE: - - MAILING ADDRESS: NEW: REMODEL: Y 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: