1985, 04-10 Permit App: 00004888 Garagev
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 ere Name first) (m) ®parime ie Only
.: . -(_"-I Ras. Comm
CI
2 o Address (not Mailing ess) .N��99m�e Space Zip
- 1 AS'c 99-2 0 6
3 Gty, •mi unity �/
State
Suubbddivlslon/Plat Name 61z51,01-X;),--)
��1 y— -)
N .�.:..r Parcel No. J
7
�10-g7 -- 0720 /
Lot
Block
I
SS
+ * f DEPARTMENT USE ONLY yr* *
5 Sic Code
Zone Act. N
Zone
Project No. �e
6 Deep N
No. of Buildings
Sq. Ft./Acre
Depth
/02.5- '
Frontage
sy '
7 Set Back -Front / � y CO
(R)S-2b !Rear
61
Census Tract
Module No.
Ini/ials1
Vt U N`
16 Architect Firm Name Street Address
Zip
Gty
State
Phone
Contact Person
Phone If different than above
( 1
rector Firm Name jn�,/,, ,• e4i-^ cy/�/7
Street
Ad-dlrelsss
Zi
Zip
G I
State
C� �
Phone
(i --e- 9) Let a 2 G,
Contact Person •
c(_ ice_
License No.
409.4 srI�14/re
Phone 11 dlflerent than above
()
8 Ow /Agent (if different than 41 above)
Susi
ess Address
9 Zip
City
State
Phone
12 Review Required
Plan Check (Y/N)
Other (Y/N)
I SEPA Exempt
(YIN)
Date
15 Type Work A Bldg
0 Fire
❑ MH
0 Demo
A New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
10 Applicant Name A
Street
Address
11 Zip
City
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.)
111
Environmental Health
W. 1101 College
Room 200
Conditions/Comments-
0]
onditions/Comments'
❑ Commercial;
❑ New Construction;
❑ Additional structure;
❑ Residential
O Bldg alteration/addition
APPLICATION #
Release
Release
w/cond 1
Hold 2
❑]
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments'
Engineers: 0 Commercial; 0 Residential; ❑ Flood Plain;
N.811 Jefferson 0 drainage 0 new access/approach; 0 fence;
O road improvements
Conditions / Comments'
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
)03
err PA
PLOT PLAN
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E. 11524 SPRAGUE (EAST OF HALPIN'S CENTER)
P.O. BOX 14652 • SPOKANE, WASHINGTON 99214
(509) 928-2276
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5. 12o5 (So wALT sL Rd .
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