BUILDING IDENTIFICATION AND DATA SHEET

Facility Name: ______________________________________
Facility Address: ______________________________________
Date(s) of Construction: ______________________________________
Date(s) of Alteration: ______________________________________

Type of Facility of Building Use: (In this space, provide information about the facility that will help you in applying the provisions of ADAAG and in using the survey data in the future. For example, is the building a place of public accommodation or commercial facility? Is it owned by a State or local government? Is it the professional office of a health care provider, a shopping center or a shopping mall, or a transportation facility?)

Number of Stories and Size of Each: _________________________________________________
Name(s) of Surveyors: _________________________________________________
Date(s) of Survey: _________________________________________________

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