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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 3o ' zs 3o MDD CIOS DE12ESi0EA.)cc .DEA E' 6 .11Zlz. 'FIz6OE(tt!--t_ cv3/4042 me.ma Fuo2 SS6rb OF l3ASSnncrUt APPLICATION i DATE s�i�J PvzZS Z�(c o PAID BY• C 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 •