1994, 03-02 Permit App 94001635 Re-RoofAPPLICATION WORKSHEET
q`f' -1 05
55�g3 � tote `a„'
OrI'G >h r Sao
General Information
Job address
/ o y g rQadGJa y
Parcel number
Owner
ri°ten kh_fgev-
Phone
Ma ding address E. /7 0z a/-oadr l/1/Gc.,
City
7
State
ZA/4sti
Zip
Site information
Legal Description
Property size
Water Distnct
Numberot: Dwellings
Buildings
Project Information
Permit Use ,fie
(
J
C
'
L
J1
Addition
Remodel
Change of use
i
_ Building Information
Dwelling units
Occupant load
Building height
Stories
Building dimensions
Iotal square tootage
Req'd parking
Handicap parlbng
Sprinkler system
Cntical Material
Square footage breakdown
a in floor
Uncovered / covered deck
Second tloor
Other
Hinished basement
Unfinished basement
Garage
Contractor Information
Heating and insulation information (R—values)
Heat source
Hat ceiling
Vaulted cethng
Above grade wall
Below grade wall
Floor
Slab on grade
Door (u—value)
Window
Furnace ctttcency
1 otal window area
% of floor area
Building contractor
G c.1-?-eV
Plumbing contractor
,
License number
Phone
License number
Phone
Mailing address
Mailing address
City, state, zip
City. state. zip
Heating contractor
Other / Lender
License number
Phone
License number
Phone
Mailing address
Mailing address
City. state, zip
City, state, zip
PROJECT CONTACT
PHONE
Spokane County Division of Buildings
1026 West Broadway Ave * Spokane, Wa 99260 * (509) 456-3675