1985, 05-29 Permit App: 00005647 Pool/85-gi-1(005
BUILDING 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) -I Department Use Only
E---rrEs /'_ [�(�i FEs. Comm
i tv (Space
2 Project Address (not(nMailing Address) cr Road Name Zip
L�T0? i �7 O 4"4"2,/ 7/
3 City/Community
.3l 0 F --Aft.
State
)
Subdivision/Plat
4 -(k
Name .� `� t/td- , [r 4
m i 62.0- 5 fi7 J r q'
.,
4 Assessor Parcel No.
i854 1-09 23
L /
w`, /`
%l/ Cj
Block
`v r�
Imo- N.
* * * DEPARTMENT USE ONLY * ,t ,t
5 Sic Code
Zone Act. #
Zone
49
Project No.
6 Dwell #
No. of Buildings
\
Sq. Ft./Acre
Depth I
30o
Frontage )
12-1-
1-7Fr1
71 Sorl-Front
ont 5 t /
(L)S-1
(R)S-2
Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
C Adt-&-Tis t•& POO LS
Street Address ` p -
! 115 l� ?wic RA
Zip _ 1
`
Gty
ca) RA -N1
State FT ,
Phone �3��) - �-7 ��� 51
nt
Conta� erso' N J L -N
License No.
1-01" * I �C ( b �
Phone If different than above
( )
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (YIN)
I SEPA Exempt (Y/N)
Date
15 Type Work D Bldg
❑ Fire
❑ MH
E Demo
New
❑ Add/Alter
❑ Replace
E Move
!9 Others M iWO-
& )
/7/(34 Z.
14 Describe Work
10 Fipli ant Name r7
%
S +'3 -S i@N
k).Z
Street Address
11 Zip
ity
State
Phone
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 nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
Conditions/Comments:
❑ Commercial;
❑ New Construction;
O Additional structure;
JS
O Residential
❑ Bldg alteration/addition
APPLICATION #
Release
Release
w/cond 1
Hold 2
1
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot wld; 0 lot size; 0 use/zone;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions /Comments:
El
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage ❑ new access/approach; 0 fence;
O road improvements
Conditions /Comments
Utilities:
N. 811 Jefferson
Conditions/Comments
Other:
c
c
c
Plan Exam
Fire Prev.
Conditions/Comments:
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
custom
POOLS & LANDSCAPING
30-6
/VP X 41"
/01,k rx/
N. 1119 PINES RD. • SPOKANE, WASHINGTON 99206 • (509) 928-5279
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