1984, 05-08 Permit App: 00001225 ResidenceSIGNATURE OF
OWNER OR AGENT
,DE ADORES' 1 \Z1—e._ Vtr-eD62\ GAC.
OWNER:
W 1%.McLA9c Pbrh.S> .
ADDRESS:
Sc 10. • rK.0`1 a
SPo 1 *o 6jc sT. agzoz
APPLICANT.
ADDRESS:
CITY: ST' ZIP:
LICENSE*:
PSO 1 - 5 5."C0G,07-
ARCH/ENGINEER:
CITY: ET: ZIP:
PAR
0514542' 1(00 z-
CENSUS TR.
INSPECTOR:
PLAT*:LOT
& BLOCK
L 2 8L -1c 1
FINAL -
PLAT
;A%RVAl..esY tSPt,la-r
=CNE aP. ZONE
POE
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zs
3o
MDD
CIOS
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.DEA E'
6 .11Zlz. 'FIz6OE(tt!--t_
cv3/4042 me.ma Fuo2
SS6rb OF l3ASSnncrUt
APPLICATION i
DATE s�i�J
PvzZS
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PAID BY•
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CG
D4:-)gityt
4'6;7.5151 *276:0.0�
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 (last) (first) (m)
HIMALAYA HOMES, INC.
Cepertrnant Use Only
FES. ✓
Comm
2 Project Address (not Mailing Address) crRoad Name Space ' Zip
11212 E. Frederick
3 City/Community
Spokane
State
WA
Subdivision/Plat Name
FAIRACRES REPLAT,
4 Assessor Parcel No.
09542-1602 _
Lot
2
Block
1
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. It
Zone
Project No
6 Dwell 0
t
No. of Buildings
Sq. Ft./Acre
Depth
1SCD
Frontage
c[Cf
7 Set Bach -Front
30`
(L 5-1(R)S-2
zs'
1
W
Rear 1 4
Bio
Census Tract
Module No.
5
I '' I
.--
16 Architect Firm Name (Street Address
Zip
City
State
Phone
1 )
Contact Person
Phone If different than above
Contractor Firm Name
HIMALAYA HOMES, INC.
Street Address
S. 104 Freya, Suite 104B
Zip
99202
City
Spokane
State
WA
Phone
1 ) 535-6602
Contact Person
Zak Parpia
License No.
Phone If different than above
8 Owner/Agent (if different than p1 above) -
Business Address
9 Zip
City
State
Phone
12 Review Required
Plan Check (VIN)
- Yes
Other (VIN)
yes
SEPA Exempt (VIN)
yr-, s
Date
15 Type Work 1731 Bldg
❑ Fire
0 MH
0 Demo
CY New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
new residence
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
44o 42 Yt tw ON 'K( anre_
SS& 41 U r "a scIE N' -s-
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
Environmental Health ❑ tommerclal; r Residential
W. 1101 College & New Construction; 0 Bldg alteration/addition
Room 200 ❑ Additional structure;
APPLICATION #
Release
Release
w/cond 1
Hold 2
it
-....i
Conditions/ 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; sidentlal; 0 Flood Plain;
N. 811 Jefferson 0 drainage new access/approach; 0 fence; c
O road Improvements
Conditions / Com men is•
Utilities: _■
N.. 811 Jefferson
Conditions/Comments•
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
•
CONTRACTOR: -
:HIMALAYA:HOMES;.:-INC.`.
PROPERTY ADDRESS:+-;
:7;E:1:
LEGAL'DESCRIPTION':
L2,.B1, FAIRACRES.:REPLA'
WATER DISTRICT: • -
IRVIN WATER DISTRICT:
°d r
. .. . _ .._ .•i.1 •