1985, 05-24 Permit App: 00005591 AdditionBUILDING 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)
Department 4 Only
//
y. ? -�// g .14-.2 i\ �p Rd
Ate.�� Comm
2 Project Address (nof Mailing Address) a Road Name Space Zip
a 7E16 o 2c- I/ fR-cts a/AsA Q996a7
3 City/Community I
Stale
Subdivision/Plat Name
SE TrArk/F0 LEG -Ai
4 Assessor Parcel No. /�
65553 0/03
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Acl. tt
Zone A _ R
,/J,!"l
Protect No.
6 Dwell If
/
No. of Buildings
v
Sq, Ft./Acrre� r ,rte
6.J File
Depth
Frontage
7 Set Back -Front I (L)S-1
(R)S-2 I Rear
it
Census Tract
Module No.
Initlals..i
m
16 Architect Firm Name 1 Street Address
Zip
City
State
Phone
1 1
Contact Person
Phone if different than above
1
Contractor Firm Name
of .n P Li in .A
Street Address
in 63 r ,gam
Zip
`y7 7 a l G
City
.
I State
Phone
( 1 a2 L7/S% P 7'
Contact Person
I
License No.
Phone If different than above
1 1
8 Owner/Agent (if different than 41 above)
Bust ess Address
9 Zip
City
State
Phone
1 1
12 Review Required
Plan
Check (Y/N)
Other (Y/N) 1 SEPA Exempt (Y/N)
Date
15 Type Work E(
0
Bldg
Fire
0 MH
0 Demo
0yp�y
3 /Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
2e5rg
eve e- A-ODr-1r6til (2 B&rJRDOMS cV 6471.1)
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( I
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
❑ Commercial;
❑ New Construction;
❑ Additional structure;
❑ Residential
❑ Bldg alteration/addition
Release'
Release
w/cond 1
Hold 2
J IK
'�G= 5
V4 �rZ^y'
APPLICATION ff
Conditions/Comments;
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot slze; ❑use/zone•
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments-
El
Engineers:
onditions/Comments-
Engineers: 0 Commercial; 0 Residential;
N. 811 Jefferson 0 drainage'. 0 new access/approach;
O road Improvements
Conditions/Comments;
❑ 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
,JOHNSON ROLLA
N 3416 BARKER
OT IS ORCHARDS
L_
D
RD
W4 99027
LEVY RATE
IN MILLS
ASSESSED VALUATION
LAND
BLDGS.
TOTAL
LEVY
CODE
R
0
1.
PARCEL
NUMBER
215
1030
1245235
05553-0103
NOTICE
—. PLEASE PRINT IN CHANGE OF TAXPAYER OR ADDRESS BELOW
NAME
ADDRESS
CITY
STATE
ZIP
CODE
YOUR TAX DOLLARS WILL BE DISTRIBUTED AS SHOWN BELOW —
STATE
COUNTY
CO. ROAD
CO. LI BR.
TOWN/TWP.
SCHOOL DIST
FIRE DIST.
TOTAL TAX
HALF PAYMENT
1
1
1
1
1
4012
FIRE PATROL
TOTAL
f
i
Delinquent
Tax as of Nov. 171966
YEAR
_—■�
REAL ESTATE
FIRE PATROL
—
MAIL STATEMENT with
CHECK or MONEY ORDER to
MERTON L. HOWARD
Spokane County Treasurer
BOX 2165
SPOKANE, WASHINGTON 99210
INTEREST
TOTAL
�tt
CALL OFFICE FOR INTEREST
• _ „ k
This Is the Legal Description of Your Property
W FARM IRR TR PL 1 PT
OF B13 EXC BEG AT NWCUR
41214 FT 10 P013
IRR 0
IRR
RID
RID
EXAMINE STATEMENT—
PAYMENTS ON WRONG PROPERTY CANNOT BE REFUNDED
090 ASSESSED OWNER �� D JUHNSUN
H 1/1FI IH E192FT TH N216F1 10 NL TH
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