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1984, 04-25 Permit Application: 84-0364 Residencegy • BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 6Wg z —, S -�w c° (Please return this original and your building plans to the Department of Building and Safety) 1 Owner's Name (last) (first) (m) Department Use Only Hollingsworth, Jim i l tti IRes. IComm 2 Project Address (not Mailing Address) or Road Name S, , ' So a e Zip 2600 block of Adams Rd. in eradale off 24th) 99037 3 Clty /Community S State S Subdivision /Plat Name 4 Assessor Parcel No. Z(p 5N 3-o < 0.1/5- L Lot B Block 5 Sic Code Z Zone Act. # Z Zone Ategi \ Project No i° 7 6 Dwell # N No. of Buildin E ` `- s Depth ` F Frontage a Application Type (Standard unless otherwise indicated) Fast Track Early Start Environmental Health W. 1101 College Room 200 DEPARTMENT APPROVALS This is not a Permit (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) ❑ Commercial; ❑ New Construction; ❑ Additional structure; ❑ Residential LI Bldg alteration /addition APPLICATION # ©_ d3�7 Conditions /Comments• Planning /Zoning: ❑ Commercial; q'6ert. of Exemption; ❑ Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot w /d; ❑ lot size; ❑ use /zone, ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions /Com •ents• Engineers: N. 811 Jefferson ❑ Commercial; ❑ drainage ❑ road improvements Conditions /Comments• EYResidential; iiew access /approach; ❑ Flood Plain; ❑ fence; Utilities: N. 811 Jefferson Conditions /Comments• Other: Plan Exam Fire Prev. Conditions /Comments• Project Representative Telephone Agencies Performing Special Inspection: 1 2 3 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold Release Release w /cond 1 Hold 2 L/.13 F i APPLICATION # ©_ d3�7 Conditions /Comments• Planning /Zoning: ❑ Commercial; q'6ert. of Exemption; ❑ Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot w /d; ❑ lot size; ❑ use /zone, ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions /Com •ents• Engineers: N. 811 Jefferson ❑ Commercial; ❑ drainage ❑ road improvements Conditions /Comments• EYResidential; iiew access /approach; ❑ Flood Plain; ❑ fence; Utilities: N. 811 Jefferson Conditions /Comments• Other: Plan Exam Fire Prev. Conditions /Comments• Project Representative Telephone Agencies Performing Special Inspection: 1 2 3 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold r 1 • Spokane County Bealtt% Piet. 'gam. st�SK, S? sT F t a- z Z J t�j `/-, oti% S `iZ o; 5�_o: -tC 2!'3 �i� G' 3 S , /z o� r3�o�1c �\ 3 �a✓2e - d5! — St N &1-- _pmt LE - 3__ F, A" '� "'_\__/ 1.i- P, g)t ooM _.. - -- _ - }} 1 - - - - -- -- - - - - - - -- - A-DvS 17 00 -t. -- �' 1-1.0-r) tt1 b �^d !� °KT. � -- , xx= - ot t. 1-P— 2 SA-tiO . / b tRT... .i=x41 x Lot to7r14 - -.Io i0o0 GM.- Se211-4-- c,w,c -- - to I ID -riot Pi F.5- PIPt ?APT, c4sl "p Sov n4 �, (o kt-ca E5 4 It PPlzgc _ V S t PA-Nit S wR'tFSt Liao - 'tY�.VYH0�1 Nh1E emTZ 2i1.% WATale- Co.v772A-or e : y -rd ;u,k52mr -mot+