1984, 12-10 Permit: 00003656 AdditionSIGNATURE OF
OWNER OR AGENT
5115 N EVERGREEN RD
OWNER:
SLAMA, RON
5115 N EVERGREEN RD
,', ,, `','
SPOKANE WA 99207-0000
H & W GENERAL CONTRACTOR
ROBERT HENSHAW
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12122 E 22ND AV
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SPOKANE WA 99206-0000
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509-924-7740 HWGENC*17ONR
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346440604
0999
0D2644
000 000
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W FARM IRR TR PL 4 PT
ZONE*:
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00C
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BEDROOM ADDITION
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5115 N EVERGREEN RD
APPLICATION �_�� ~�%
DATE y«- ~y'
0003859
12/10/84
00003656
Structure Fee $68.00
FEES:
COUNTER
$68.00
STRUCTURE E~MIT
STRUCTURE
Description A DWELL Group R-3 Type VN
Square feet 000224 Occupancy Load 0000
Est Pin Chk $0.00 Actual Pin Chk $0.00 Var
PAID BY:
PLANS EXAM:
CA
X
=
CG
NC
"°='
12./10/8
TOTAL FEES $68.00
$0.00
OFFICE COPY
17~10-~8 867lu *6880�.�
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 conditi
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
❑ Commercial;
O New Construction;
O Additional structure;
APP C•T
ditions/Comments: +,
Com'
O Residential
❑ Bldg alteration/addition
Ail` 1.A.JIsti-
Release
Release
w/cond 1
Hold 2
RIJr•
rte. 1 A
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; 0 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
Na
ccr\O (NI -C
---777/7?Thl
Art 41 6-- •