1985, 08-28 Permit App: 00007132 Garage(r
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 me (last) (f' st) (m)
Department Use Only
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2 Projec ddress (not 'ling Address) or Road Name Space Zip
3 City/ munity (►
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State
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Subdivision/Plat Name
L'catf<i n Heti P 6-c2- Acif -a
4 Assessor Parcel No.
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Lot
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Block ,
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* , . DEPARTMENT USE ONLY
5 Sic Code
Zone Act. #
Zone h ; '''. r) )
Project No.
6 Dwell #
No. of Buildings
Sq. Ft./Acre
%%?ij
Depth
/0-4'
Frontage
t0'.-1
7 Set Bads -Front (L S-1
-FK � T7 NC, I ." `
(R)S-2 Rear
_5" ' 1
Census Tract
Module No.
Initials
_.1u i o
' 16 Architect Firm Name
I Street Address
Zip
City
State
Phone
( )
Contact Person
INC.
Phone if different than above
( )
,,s AI Cel- D�Ne4.
ContrlC�i' E. 115 SPRAGUE AVE.
SPOKANE. Wl'/__ 206
Street Address
Zip
City 1 State
Phone
Contact Person
License No.
Phone if different than above
8 O ner/Age t (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA
Exempt (Y/N)
Date
15 Type Work ) Bldg
0 Fire
❑ MH
0 Demo
A New
0 Add/Alter
❑ Replace
0 Move
0 Other
14 Describe Work
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
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
❑ Commercial;
❑ New Construction;
Additional structure;
APPLICATION # A-6426 C
O 0
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
)1/77K
Conditions/Comments.
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot wld; ❑ lot size; 0 uselzone;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions/Comments.
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new accesslapproach; 0 fence;
O road improvements
Conditions/Comments.
Utilities:
N. 811 Jefferson
Conditions/Comments:
Other:
ek
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
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