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1992, 06-03 Permit App: 92003968 Reroof Spokane County DEPARTMENT OF BUILDING & SAFETY West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 INFORMATION WORKSHEET PARCEL NUMBER: // / 2 STREET ADDRESS: �9 )z L3 _ CITY/STATE/ZIP: Ice h42- SUBDIVISION: BLOCK: LOT: ZONE: DISTRICT: LOT AREA: F/A: WIDTH: DEPTH: R/W: # OF BUILDINGS: # OF DWELLINGS: WATER/iDISTRICT: J ,J 1/ g -"/O2� S2- 7 OWNER: (��(CY�/�l 'r( (��`-'''S� PHONE: [ MAILING ADDRESS: 625Oç5,4 2 h e'r\--� CITY/STATE/ZIP: . G>1(Q ,LE A),71- ,629c CONTACT: PHONE: SETBACKS: - FRONT: LEFT: RIGHT: REAR: PERMIT USE: **************************************************************************** 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: r-- ' 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: Fiat ceilings R Doors U Vaulted ceilings R Windows U Above grade walls R Glazing area 0/0: 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: