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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 F---I—Th . ar. i 1 , r 4. II +�iI s, ' - -4`— r I Ii 1 —{ (! I 11 I I fi ► ■■■ cxce�rt-, PE j L i , ■■ �■■ ki i aV?. I _ 1 r �t T N ■,1 I _L- T I yas lihall;, 'k _ al- k I\ a - - - - >- T -i x x a k'—N—X-A- =Y -)x x ac x -1—k! IL X\,x( x 1. \ x T '— f - � ;-F -r f 1 x ^n to • X • 0 1 � ' y. N� -r r -- x ( ') 'X PC. ,iii k± r i1 '5O; T, J fir: rc Cie • kb train ■~� :S t -,m ■ �1 XI II I • k 1, r— 701 x•' T -I. x ; ,---I — I■ - - - - — t x 31 ■ ■■■ ^ . . I _ 1■ 141 o-� — II RA. Clk az �U ■:Ee- QI L._,I j , ( I 1 N ■ Sea ESI"=4 �Q( I J