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1984, 05-14 Permit App: 00000155 Residence* BUILDING 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 (first) (m) Department lbe ly /}-�� ^ / P. Comm � �'��� � I /! \[ , 2 Project Address (no Mailing Address) a Road Nam e� Space Zip .Ji `2 z /-`ifl u�� 995-' 6 3 City/Community State Subdivision/Plat Name 4 Aseeeeor Parcel No Q95-17.--e75— Lot Block * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. 0 Zone 961/46(21 Project No. 155 6 Dwell# No. of Buildings Sq. Ft./Acre Depth` Frontage v 7 Set Back -Front 3 (L S-1 181 (R)S 2 61t Rear Census Tract Module No.Ipdial�� �- � /) 16 Architect Firm Name / A/ / 1G/'� f� Street Address Zip City State Phone ( ) Contact Person Phone If different than above Contractor Firm N'C / �/V C - Street d -C` � ` /J 7 - Zip 992/ Gty x° State Phone .Orf 9X -s -7.r0 pnse N -¥/ 7 ! conte Per /41 �A` ,,rXBusiness Phon(if differe)t than above 8 Owner`//Agent (if different than 01 above) Address 9 Zip City State Phone ( ) 12 Review Required PlanCheck (Y/N) Other (Y/N) ISEPA Exempt (Y/N) New Date 15 Type Work Bldg ❑ Fire ❑ MH ❑ Demo ❑ Add/Alter ❑ Replace ❑ Move ❑ Other 14 Describe Work =i Ov C- 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 m- F -_-= 9 1 Z, 9. F. 4 X76 u g . :- 9 \ 7, s F. pF.g_ _ qX° Application Type (Standard unless otherwise indicated) Fast Track Early Start Environmental Health W. 1101 College Room 200 Conditions/Comments• DEPARTMENT APPROVALS This is nota Permit (Indicated approvals required in either "release" or "release with conditions" space prior to permit Issuance.) ❑commercial; E4rtesidential New Construction; ❑ Bldg alteration/addition ❑ Additional structure; APPLICATION # 79 fid/ Release Release w/cond 1 Hold 2 Planning/Zoning: N. 721 Jefferson Conditions/Comments. ❑ Commercial; 0 Cert. of Exemption; 0 Frontage; O Setbacks; 0 lot w/d; 0 lot size; 0 use/zone; ❑ CU, variance, zone change; shoreline; 0 fence; O Other Engineers: N. 811 Jefferson Conditions/Comments. O Commercial; O drainage O road improvements r7 sidential; LV new access/approach; O Flood Plain; O fence; „s& 6/7fri Utilities: N. 811 Jefferson Conditions/Comments. Other: Plan Exam Fire Prev. Conditions/Comments• Tl 0 Project Representative Agencies Performing Special Inspection: 1 Telephone 2 3 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold TE PLAt\l- a7r /6 av-a-(2,1' Ce is' F 1 06122- Fai r v i cvi bed `1 ba+h N o 9a.ralei laoot;oskot! sed G k parcel -kG1542-0765 Z1 F EDEPtCK S cote Spokane County DEPARTMENT OF BUILDING &SAFETY West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 PARCEL NUMBER: INFORMATION WORKSHEET STREET ADDRESS: C A0V.22 .22 fair vie ti 4oe, CITY/STATE/ZIP: %% DCI k_abt e Weic c 97206 SUBDIVISION: Fczf r" a, C /es BLOCK: 36 LOT: ZONE: DISTRICT: LOT AREA: F/A: WIDTH: DEPTH: R/W: # OF BUILDINGS: #�OF DWELLINGS: WATER DISTRICT: �/ OWNER: J GL (/14 e 5 (/)'•CGe ,7 4 PHONE: - `2 ( - .3 7 MAILING ADDRESS: GC, e CITY/STATE/ZIP: CONTACT: PHONE: - - SETBACKS: - FRONT: LEFT: RIGHT: REAR: PERMIT USE: *************************************************************************** BUILDING INFORMATION CONTRACTOR LICENSE NUMBER: CONTRACTOR: PHONE: MAILING ADDRESS: ARCHITECT/ENGINEER: PHONE: - MAILING ADDRESS: NEW: REMODEL: ADDITION: CHANGE OF USE: DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: / STORIES: /e) 4E00 ENE. BUILDING DIMENSIONS: X ,3(WIDTH X DEPTH) SQ. FT.: J� REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL: