1985, 05-28 Permit App: 00005600 ShedBUILDING 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)
Department yie Only
A' 1-401
R38. Comm
2 Project Address (not Mailing Address) a- Road Name Space Zip
C A R NA -f -f -A4\)
3 City/Community
. s. -74::_j,4-7,-- i.i, ,.,-• :......
State
/-1....--'14 1- 74-1
Subdivision/Plat Name
(111 .4 A ,' L. / X ,
4 Assessor Parcel
-1
. 3 5- 3
No.
1 - 1 0
4
Lot
/
Block
3
* * * DEPARTMENT USE ONLY * * *
..--
5 Sic Code
Zone Act. #
Zone
Project No. 1
6.C1 C- ICj
6 Dwell #
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front
(L)S-1
(R)S-2
Rear
nsus Tract
Module No.
Initials
16 Architect Firm Name
1
Street Address
Zip
City
State
Phone
(
Contact Person
Phone If different than above
( )
Contractor Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
License No.
Phone If different than above
( )
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( 1
12 Review Required
Plan Check (Y/N)
Other (Y/N) [ SEPA Exempt (Y/N)
Date
15 Type Work ;14., Bldg
7 Fire
0 MH
C Demo
0 New
X Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
1 ? V+ O'F/P
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone If different than above
( )
Additional Information
DEPARTMENT APPROVALS
•
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
iins iuHut drt:rnnt
(Indicated approvals required in either "release" or "release with conditions"
to issuance.)
space prior permit
Release
Release
w/cond 1
Hold 2
•
Environmental Health ❑ Commercial; ❑ Residential
W. 1101 College ❑ New Construction; E Bldg alteration/addition
Room 200 ❑ Additional
structure;
APPLICATION #
Conditions/Comments•
•
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
0 CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/ Comments*
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
0 road improvements
Conditions/Comments•
•
Utilities:
N. 811 Jefferson
Conditions /Comments:
Other:
•
Plan Exam
Fire Prev.
Conditions/Comments.
Information ❑1
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
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Dean & Janet Eck
9418 E. Broadway
Spokane, WA 99206
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