1986, 07-17 Permit App: 00012321 Residence(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
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Project Number 1232/
Owner's Name LAST FIRST MI
CD f'.2,ASP`� /.2-A/C___
Project Address (Street N. e & Number) Zip
/Il' 5O 1 6 3 %yr AO,
Applicant
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Address
g e- SKr- / 3 7/ 7
City
State
Zip
Phone
( ) QJZ 2. -Z' -ZOO
Business Phone
( )
Contractor /Agent
Address
City
State
Zip
Phone
( )
Contact
License Number (Required)
Business Phone
( )
Architect /Engineer
Ste-,-- -
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
( )
Describe Work
Si PEI)c w/ 6-A2A&E
Res.
Comm.
Subdivision /Plat Name/Short Plat Number
19/6,-(,. - no Ill o
Assessor Parcel Number
t3SC.,43 -07I (POnfilor30F
Lot
Block
__
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft. /Acre)
Depth
Frontage
Front Setback
Left Setback
Right Setbac
Rear Setback
R/W Width
Additional Information
/
Square Footage
/II- l2 -- M'
I_ BUILDING INI
Numberof Bedrooms
Building Technician
Date /
Group
Type
Legal Description
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Show on Site Plan:
Additional Information:
Lot Dimensions
Landscaping
Existing Structures
Drainage Plan
Proposed Improvements
Hydrants
StrnctureSetbacks
Topography
k Easements
Lighting
t Septic System (s)
Signage
Water Lines
Shorelines
Sewer Lines
Highwater Mark
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Legal Description
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DEPARTMENTAL REVIEW
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile s -id - •plication is true and correct.
Signatur
Date
Approved
Cond.
Approval
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Health Application # 1
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Environmental
W. 1101 College
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r INEINIIMIM
j Planning /Zoning
4Y 1.� iip
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N. 721 Jefferson
`24 ';- 44, 41-4e"4V
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Engineers
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N. 811 Jefferson `L
Utilities
I
N. 811 Jefferson
Plan Review /Fire Prevention
1 N. 811 Jefferson
Other (SEPA /Critical Material /etc.)
] Fast Track /Special Inspection Information
Project Representative
Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile s -id - •plication is true and correct.
Signatur
Date
CROSBY
Realty
FULL REAL ESTATE SERVICE
QUALITY.CO ISTRUCTION • LAND DEVELOPMENT
TEL. 922 -2200 • N. 1506 PINES ROAD • SPOKANE, WA 99206
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i ROSBY
TERPRISES
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CROSBY-
FULL REAL ESTATE SERVICE
Realty
TEL. 922 -2200
i ROSBY
la TERPRISES
{ QUALITY .CONSTRUCTION •'LAND DEVELOPMENT
N. Sob PINESROAD • SPOKANE. WA. 99206
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