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1986, 05-05 Permit App: 00010828 Garage- (THIS IS NOTA PERMIT) 55, 56 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) SHADED AREAS Alit -UH UtYAH I M ti' I AL U ,• - Prolect Number f: Owner's Name LAST FIRST MI . /4Ze_ MG�.x q6)o 7 Project Address (Street Name & Number)/� Z'p A, . L/! G 6J a- 0 e-t/t CO/Ne Applicant Address City State Zip i Phone ( ) . Business Phone ( 1 Contractor/Agent . - /c ru r' ---C Address 7 ?o 6 e- . spr�C.Q% ‘Ae .3 City State -n_i- . Zip Phone �} `' r Contact � % i) s :License Number (Required) - Pc s [-666.3 Business Phone ( ) .QZ-7-0G SS' Architect t Engineer Address City State I Zip Phone f I ContactBusiness • Phone ( ) -� Lender Address City State Zip Phone- r(� ) . 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GUEj #3 • bPOKANE, WA 99212 a (509) , , 1 ... ... _ 927-0655 _ __ , 1 1 1 0 0 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 said application is true and correct. Signature Date Approved Cond. Approval Approval Hold Environmental Health Application # G A 6 ' ♦ ,� . - W. 1101 College Room 200 1 Planning/Zoning Ni 721 Jefferson - Engineers N. 811 Jefferson Utilities N. 811 Jefferson Pian Review/Fire Prevention 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 said application is true and correct. Signature Date