1985, 04-19 Permit App: 00005027 GarageBUILDING 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) [/%,�
CO(first) r (m)
�citn
Department Use ly
Res. Comm
2 Project Address (not Mailing Address) or Road Name / Space Zip
3 City/Community
) e ececlot( e
tate
W Ck
Subdivision/Plat Name
mYs.
4 Assessor Parcel No.,Lot
r. 2 6-jf� --1/30/
((Zone
/
Block
I /
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Act. #
Zone srp
Project No.
6 Dwell #/
No. of Buildingsp
1
Sq. Ft./Acre
Depth
Frontage
7 Set Back -F � I (L)S-1(R)S-2
1 Rear
Census Tract
I Module No.
Initialer Ha)
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
Street Address
Zip
City I State
'State
Phone
( )
Contact Person
License No.
Phone if different th§0 above
(5Q) 4_ - (T779
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
r SEPA Exempt (Y/N)
Date
15 Type Work Bldg
0 Fire
ID MH
0 Demo
W. -New
❑ Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
4 -r -14 -Oiled C' -Aryl_ e 5(0o 0
10 Applicant Name
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 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 stru,ture;
❑ Residential
❑ Bldg alteration/addition
APPLICATION # U
Release
Release
w/cond 1
Hold 2
.�, 1117`_'
�4
/
Conditions/Comments•
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; ❑ lot size; 0 use/zone;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions/Comments•
Engineers: 0 Commercial; 0 Residential;
N. 811 Jefferson 0 drainage ❑ new access/approach;
O road improvements
Conditions/Comments•
O Flood Plain;
O fence;
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
Plan Exam
Fire Prev.
Conditions/Comments•
Project Representative Telephone
Agencies Performing Special Inspection:
1
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Carl Kappen &
Associates, Inc.
N. 25 Mullan, Suite 304, Spokane, WA 04208
Phone (509) 422-1840
PLOT PLAN
Requested Price 4/ 9,50
Lot Cost SOO
ELEVATIONS:
Crown of Street
Finish Floor
Scale: ,~p
asic: .700 - -1 sq. Ft. aQ
HA Case# 1Job# !�
ortgage Co
)wer Col rct,
umbe
Legal
Address:
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