1984, 06-26 Permit App: 00000881 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 Narne (last) (first) (m) Department Use Only
t
I
lye i r f ! i,/yam L.! LI N(...--, I -, Res. Comm
2 Project Address (not Mailing Address). ar Road Name Space Zip
–5 0 Z / r1 /1 / ti , j V`Y /-1 _ /'
3 City/Community
State
Subdivision/Plat Name
4 Assessor Par
` 2 — ��
Lot
/G
Block
]d\
* * * DEPARTMENT USE ONLY * *
5 Sic Code
Zone Act. N
Zone
Protect No.
6 Dwell N
1I45
No. of Buil ings
Sq. Ft./Acre
Depth
Frontage f
q
7 Set Back -Front (L)S-1 (R St2 i(
Fxti ►
Rear t
6
Census Tract
_TR_____....--
Module No.
l
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
G tJ
K)
Street Address
/ ' . L . v'�1
Zip
aty
�r rfJ *,�'`�� -_2)
State
Ck._
Phone
( ) 9 -6-7 c,
Contact Person
' License No.
Phone If different than above
( )
8 Owner/Agent (if different than a1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
•
SEPA Exempt (Y/N)
Date
15 Type Work Bldg
❑ Fire
❑ MH
E. Demo
❑ew
U/AAdd/Alter
❑ Replace
❑ Move
❑ Other
14 Describew'r�
X1111 q C., 1- Ci r_ t e w roi y t A c. D
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
i 1
Contact Person
Phone if different than above
( )
Additional Information
to
c
0
N
co
0
U
0
F
0
0
LL
DEPARTMENT APPROVALS
•
ID
Application Type
(Standard unless
otherwise Indicated)
Fast Track
arly Start
1 nis is nota rermit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Release
Release
w/cond 1
Hold 2
Environmental Health 0 Commercial;C7 esidential
Room �ollege 0 New ,❑ Additionalstrtioe'Bldg tus
—W.
1��,,_�„ey--
�alteration/addition
APPLICATION #
•
Cond itions / Comments•
•
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; IBesiEl Flood Plain;
N.811 Jefferson 0 drainage 0 0 fence;
Gm�f
S.�
new access/approach;
❑ road Improvements
Conditions/Comments'
El
Utilities:
N. 811 Jefferson
Conditions /Comments•
Other:
•
Plan Exam
. Fire Prev.
Conditions/ Comments •
Information ❑'
Project Representative - Telephone
Agencies Performing Special Inspection:
1
2
3
1 Indicate above or attach condltlons relative to final as built approval
2 Indicate above or attach reasons for hold
BACK PROPERT`C LINE
DESCRIPTION
LOT c:C0 IN BLOCK 12 EARLY DAWN FIRST ADDITION
AS PER PLAT THEREOF RECORDED IN VOLUME
12 OF PLATS PAGE -2:
COUNTY OF SPOKANE STATE OF WASHINGTON [1'
0
1.4 G"
9
c0
DWELLING
0 Z
d
in 0
0
a -
a
« 0
a Q
FRONT PROPERTY LINE
9' -colt
z
J
SIDE PROPERT•f,
ST REST
92,o 'F T
1
1-
0
0