1984, 09-21 Permit: 00002445 GarageSIGNATURE OF
OWNEF OR AGENT
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1215 N ARTIES CT
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WAACENAAR, PETER H
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1215 N ARTIES CT
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LIBERTY LAKE WA 99019-0000
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UPPER COLUMBIA
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U,E OF PERMIT:
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APPLICATION -�� �zL�
DATE � ~-��/-U
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0002552
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09/21/84
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00002445
Structure Fee $61.00
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$61.00
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09/21/8'
STRUCTURE "P MIT
STRUCTURE
Description N PRI GAR WF Group M-1 Type VN
Square feet 000520 Occupancy Load 0000
Est Pln Chk $0.00 Actual Pin Chk $0.00 Var
TOTAL FEES $61.00
$0.00
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OFFICE COPY
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
JoB ADDRESS: SEG. A: DATE: PROJ.:
•
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OWNER:
ADDRESS:
CITY: ST: ZIP:
APPLICANT:
CONTRACTOR:
ADDRESS:
CITY: ST: ZIP:
PH: LICENSE A:
ARCH/ENGINEER:
ADDRESS:
CITY: ST: ZIP:
PARCEL*: CENSUS TR: INSPECTOR:
PLATS: LOT AC BLOCK FINAL
PLAT NAME:
ZONES: ZONE ASS 5-1 5-2 RSB MOD -'
USE OF PERMIT: -
FEES: PAID BY:
JOB ADDRESS:
COUNTER APP: PLANS EXAM: DATE:
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BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) (first) (m)
t. (V 4 A 7 e I` N r �°
Department Use Only
Fis. Comm
2 Project Address not Mailing
K •
Address) cr Road Name Space Zip
2_1 AP 5 ct D/‘
3 City /Community
' Q ui c r'
State
\/V'4 5 h I
Subdivision /Plat Name
J C- o 1 b �V\ b
4 Assessor -" ssessor Parcel No.
I L J S1 . 4 2, 1 0
Lot
�
I Block
4/`
. + + DEPARTMENT USE ONLY * * *
14 5 Sic Code
Zone Act. #
Zone
Project No
6 Dwell #
No. of Buildings
I
Sq. Ft. /Acre
Depth
Frontage
/ O t
lls
7 Set Back -Front (L S -1
1 ( t
(R)S -2
Rear
Census Tract
Module No.
Initials
t 16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
License No.
Phone if different than above
( )
8 Owner /Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone q 2-el ( ) l 8
2--
12 Review Required
Plan Check (Y /N)
Other (Y /N)
SEPA Exempt (Y /N)
Date
15 Type Work j Bldg
❑ Fire
❑ MH
❑ Demo
❑ New
IA Add /Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work(]( , ^�, c^ t
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
Conditions/Comments-
❑ Commercial; ❑ Residential
❑ New Construction; ❑ Bldg alteration /addition
Fr Additional ructure;
APPLICATION #
Release
Release
w /cond 1
Hold 2
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; ❑ lot w /d; ❑ lot size; ❑ use /zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
❑ Other
Conditions /Comments•
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N. 811 Jefferson ❑ drainage ❑ new access /approach; ❑ fence;
❑ road improvements
Conditions /Comments•
Utilities:
N. 811 Jefferson
Conditions /Comments•
Other:
❑ Plan Exam
Fire Prev.
Information
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