1992, 05-26 Permit App 92003691 Sewer-Dry Liner .
Spokane County
DEPARTMENT OF BUILDING &SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET
PARCEL NUMBER:
STREET ADDRESS •. l D l o 8 ��� ���' L
CITY/STATE/ZIP: 512D 0. '
SUBDIVISION: poli J -C rg os r
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
OF BUILDINGS: OF DWELLINGS: WATER DISTRICT:
OWNER: C 6 N N r,L— PHONE: -
MAILING ADDRESS
I
ITY/STA TE/ZIP:
ONTACT' % k
SETBACKS: - FRONT:
So/"S f kC F?VPTirvb
PHONE:
LEFT: RIGHT: REAR'
PERMIT USE:
**kk*************k**k*******k*k**k*ktek********k***kkkk***k*k*****k*k**k***kk
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:
CONTRACTOR: H+/G ` J.6 N -r 1- r C � ,/ � d
ME
PHONE: Su'I - 5zi - `7;z2- /
MAILING ADDRESS:
F / i ll (. M e,�g o r -.-..a. �+-Y �j�r-eQ�✓u,li�,+._. _ Lia . 9 �I o/L
ARCHITECT/ENGINEER:
MAILING ADDRESS:
PHONE:
NEW; REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.:
REQUIRED PARKING: _ # HANDICAP:_ SPRINRLERED:_ CRITICAL MATERIAL:_
Please provide the following information for Energy Code compliance:
Space heating type (check one)
Forced air electric
Forced air gas
Electric baseboard or wall mount
Heat pump
Propane
Other:
Flat ceilings R Doors U
Vaulted ceilings R Windows U
Above grade walls R Glazing area 4'a:
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: