1985, 11-05 Permit App: 00008532 Roof Cover(THIS IS NOT A 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) O S 7 2/
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I Protect Number��J .
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Owner's Name LAST //� FIRST MI
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ee
Project Address (S eet Name & Number) Zip
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Applicant
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Address
44c , S ,9, �T
City
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State
`—,11
Zip
`7nyie
Phone
( ) 9�7_4/6'7%.l-
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Business Phone
Contractor/Agent
Address
City
State
Zip
Phone
( 1
Contact
License Number (Req Ired)
Business Phone
1 )
Architect/Engineer
Address
City
State
Zip
Phone
( 1
Contact
Business Phone
Lender
Address
City
State
Zip
Phone
1 )
Describe Work
� Fit"" /` � i
L Y Z
Res.
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Comm.
Subdivision/Plat Name/Short Plat Number
W Aml (rC ts`(
o
Assessor Parcel Number
35 G4 3 - Leib &
Lot
G.,
Block
t
Plat Number
Pertinent File Numbers
Zone
5r_a-
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Front Setback
Left Setback
Right Setback
Rear Setback
R/W Width
Additional Information
BUILDING INFORMATION
Square Footage
Number of. Bedrooms
Building 'Technician
i0NI
{Date QQ/
I I`S 4
Groupg
Type
Environmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Application #
Approved
Cond.
Approval
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
O N. 811 Jefferson
Utilities
O N. 811 Jefferson
Plan Review/Fire Prevention
❑ N. 811 Jefferson
0
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Protect 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.
First Addition, as recorded 1n
of Pageyot:-
5, swan Acres c tors orfice, wash' n:,u
of plats, Spokane County Auditors 48 ,
Owners: Jasper C. & Ruth M. Adkins
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