1985, 04-18 Permit App: 00005002 ResidenceBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
3810 eO
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) (first) (m)
r _/
<•FO �, i/k7-4^,/'/SF:� /..,),,_
Department Use Only
F s.
Comm
2 Project Add (not Mailing Address) ar Road Name Space Zip
N 50.2 I reNNell/ Vic/ CCl2 /G-
3 City /Community
44.-.W
State
L. ',.•v
Subdivision /Plat Name
1,0'.::14 f-r ..1-4 ef\s
4 Assessor Parcel No.
`_� L t/ c --1 //
Lot
Bloa Tjvi-c -/
N I/ S * * * DEPARTMENT USE ONLY
5 Sic Code
Zone Act. #
Zone Project No. /^
/ P % 5ccv
6 Dwell #
No. of Buildings
Sq. Ft. /Acre
Depth
Frontage
7 Set Back -Front
I (L)S -1
(R)S -2
f Rear
Census Tract
1 Module No.
Initials
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
0/57-4)`,;1,512, ..1f�1`,c.,Git'iSZ', -JJ / ,.
Street Address
/- 6): ✓.S.1y/ ?"7/�
Zip /
Z / 3
qty /
3. <, 1611•C._
State
LL.,
Phone
(jv ) 92 -7 - -7 tar ti
Contact Person
1Z' e `— Cereciic
License No.
C ,2o 7?/'). I/ ,i ilF 2 ! Er N L
Phone if different than above
( )
8 Owner /Agent (if diff ent than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y /N)
Other (Y /N)
SEPA Exempt (Y /N)
Date
15 Type Work 6✓Bldg
❑ Fire
❑ MH
❑ Demo
4 -New
❑ Add /Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
re S , M0 e, c.v /6161,60-e-,
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
/-IF = /1/1 2
u 13 - 111/2
C4-R =q17
*
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.)
Eff
Environmental Health
W. 1101 College
Room 200
Conditions /Comments•
❑ Commercial;
❑ New Construction;
❑ Additional structure;
❑ Residential
❑ Bldg alteration /addition
APPLICATION # 85 �� `�j� Li
n i
s D�-
Planning /Zoning: ❑ Commercial; I C rt. of Exemption;
N. 721 Jefferson ❑ Setbacks; ❑ lot w /d; ❑ lot size;
❑ CU, variance, zone change; shoreline;
Other
Conditions /Comments•
❑ Frontage;
❑ use /zone;
❑ fence;
Engineers:
N. 811 Jefferson
Conditions/Comments.
❑ Commercial;
❑ drainage
❑ road improvements
❑ Residential; ❑ Flood Plain;
❑ new access /approach; ❑ fence;
Utilities:
N. 811 Jefferson
Conditions /Comments•
Other:
Plan Exam
Fire Prev.
Conditions /Comments•
�l N u S e (1 l /1/6 E Ordee
PO
1
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
i
Planning /Zoning: ❑ Commercial; I C rt. of Exemption;
N. 721 Jefferson ❑ Setbacks; ❑ lot w /d; ❑ lot size;
❑ CU, variance, zone change; shoreline;
Other
Conditions /Comments•
❑ Frontage;
❑ use /zone;
❑ fence;
Engineers:
N. 811 Jefferson
Conditions/Comments.
❑ Commercial;
❑ drainage
❑ road improvements
❑ Residential; ❑ Flood Plain;
❑ new access /approach; ❑ fence;
Utilities:
N. 811 Jefferson
Conditions /Comments•
Other:
Plan Exam
Fire Prev.
Conditions /Comments•
�l N u S e (1 l /1/6 E Ordee
PO
1
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
CROSBY FULL REAL ESTATE SERVICE
Realty
` ROSBY
NTERPRISES
QUALITY CONSTRUCTION • LAND DEVELOPMENT
TEL. 922 -2200 • N. 1506 PINES ROAD • SPOKANE, WA, 99206
E6AG /,e"-_/-4-,47,477/4"A"
TEE X80dD 77
/!///• 7;egcr- / /S'o --" AVesr
`f/R.*9t r.Pit /6,97 /iYfJG7-S-
/1/
Rc
� .ecEG "P _3-c- g- 1 J -.C7 7/ /