1992, 08-13 Permit App 92003416 Re-RoofSpokane County
DEPARTMENT OF BUILDING & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
PARCEL NUMBER:
INFORMATION WORKSHEET
STREET ADDRESS:
CITY/STATE/ZIP:
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
# OF BUILDINGS:
OWNER: (7j
# OF DWELLINGS: WATER DISTRICT:
PHONE:
MAILING ADDRESS: %�
CITY/STATE/ZIP: 07f� Gtii‘0 (x11
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CONTACT: PHONE:
SETBACKS: - FRONT:
PERMIT USE:
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LEFT: RIGHT: REAR:
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CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
BUILDING INFORMATION
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PHONE: - «ZD - 7 Zsr7
MAILING ADDRESS: S i !vC 3 ',4q 5
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: REMODEL: 1c,DITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.:
REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL:
Please provide the following information for Energy Code compliance:
Space heating type (check one)
Forced air electric
Forced air gas
Flat ceilings R
Vaulted ceilings R
Above grade walls R
Below grade walls R
Floor R
Slab on grade R
Electric baseboard or wall mount Propane
Heat pump Other:
Doors U
Windows U
Glazing area %:
Total floor area
of heated space
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: