1984, 05-15 Permit App: 00000225 Addition*
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
• NameI(last) (flat) (m)
' S^/u /k/ 4-7 - .c/frer . Ric.A.QhQ:
Department Ude Only
Fes. Comm
2 Project Address (not Mailing Address) a Road Name • Space Zip
Si /be042V Fh&dev/c k r'J
3 Clty/Community
Spokane.
State
4v0-,
Subdivision/Plat Name
Mir aAea& an-AryJCH
4 Assessor Parcel No.", ,
3°
Lot a
Q. Black
* * * DEPARTMENT USE ONLY * * *
06/5-C1 i -
/ 5 Sic Cada
Zane Act. M
Zona dt 6
7�1,
-
Project No.
B Dwell M L.
No. of Buildings
2-
Sq. Ft./Acre
Depth
12-(
Frontage
®o I
Set Beds -Fant ' _ I (L
f� I‘jl''\119-
IR
•
FAC
Census Tract
Module No.
Initials7
Vt 1Q
16 Architect Firm e, NamStreet Address
14
/A.Zip
-
City -
State
Phone
( 1
Contact Person
Phone If different than above
( )
Contractor Firm Name
-L-5 1.01/1/g. ._
Street Address
Zip -
City
I State
Phone
l )
Contact Person -
License No.
Phone if different than above
8 Owner/Agent (if different than 41 above)
._s'F--
Business Address
9 Zip -
City
-
State
Phone
( )
r 12 Review Required '
Plan Check (Y/N) ..
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work 0 Bldg
0 Fire
0 MH
0 Demo
y❑ New
,4-\ Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
f}ddl iilon -io house_ 8 $ c2s21
10 Applicant Name '
E /s -n S/, u
i, Ike.;
Street Address •
E /o,7 Fre1er.c
/2-o.2/2-o.2_,7er
11 Zip
97.2_06,
City
sSfic e,
State
ltJa.--
Phone
(so?) Pa K -o 707
Lender . Street Address
tvcosh /ny/oh Se/110o/ L •-y/oyees dr. Z/n/y,n ass bQsf/Q.&/00- 3 '' ,
Zip
95109
City
Seayile
State
uidsh
Phone
�y7
Contact Person
Phone if different than above
Additional Information
*
*
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required In either "release" or 'release with conditions'
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
Conditions/Comments-
• Commercial;
❑ New Construction;
❑ Additional
structure;
APPLICATION q Id' /T
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
NI
1/7,46A. ri-ettAe— SI zi, 1cnn it
4 U
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'
Protect 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
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