1986, 05-05 Permit App: 00010829 Garage(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
l3 56
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)
SHAD
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Project Number /D Q . /. r
(L /
Owner's Name LAST FIRST MI J
(nuc G,Im q q 0454
Project Address (Street Name & Number) Zip
_
Applicant
Address
City
State
Zip
Phone
( )
Business Phone
( )
Contractor/Agent
0ll-"`Q— Su-res
Address
7z -f26 (.LQ-----
City
State
Zip
Phone
Contact
L Z�w;
Liregse Number (Required)
;�okie?.s 1 b6 (...._'s
Business Phone
( ) 9;- 7 -- 6-6 SS
Architect/Engineer
Address
1
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
(
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1Cl tb (A t?A X )
Res. /
✓
Comm.
/Short Plat Number
'3'
a488Or.P'arcelNumber
.g£= SS -At" 63i2*
Lot
/2
Block
3
Plat Number
In Fife Numbers :
I :
Zone
re
Comp. Plan
Census Tract
ts '=:.
UniG
Number ofBuildings
-
Lot Size (Sq. Ft./Acre)
Depth
Frontage
,.:.,:
Left Setback
Right Setback
Rear Setback
R/W Width
1 BUILDING INFORMATION
Square Footage
Y
P.
,• �� g
•Date
Number of Bedrooms
75—S to
Group
Type
DEPARTMENTAL REVIEW
/6)
Approved
Cprov
A royal
pP
Hold
' Environmental Health Application # X1.5--- �
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a
W. 1101 College
Room 200
CsyvVtattle ..Q.....)_4___,...../
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
I
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
ct-d(ce ce-
le` /z 734dr 3
Get -----A, la I Z Py t'
E. 7406 SPfiAGUE
..3 • !SPOKANE, WA 99212'• (09) 927-065�I
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