1984, 05-14 Permit App: 00000190 Deck•
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) (m)
Dspsrtment Use Only
/� / r�( �((fiirrst)) n
WAGMA-A R(cttAtto G��
�_ t/
Comm
2 Project Address (not Mailing Address) a Road Name ' Space Zip
5. SIS Hot,1-ow c(r{.p/
3 City/Community
SPOKFIT-Li
State
WA,
Subdivision/Plat Name
CO ZCST 'MEArow IST MDO
4 Assessor Parcel No.
"357(T _ ktof
Lot c
i1_
Block
r a + DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act.*
Zone
''F-2.._
Project No
140
6 DwelI4
No. of Buildings
Sq. Ft /Acre
Depth
Frontage
7 Set BS -Front I (L),5-1
t Ell
(R)S-2 j Rear
it
® haus Tract
Module No,
``Tl .
I tials
� ^ —
:. 16 Architect Firm Name I Street Address
Zip _
qty
State
Phone
( 1
Contact Person
Phone If different than above
( )
Contractor Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
License No.
Phone If different than above
8 Owner/Agent (if different than 11 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
AC 5
Other (Y/N) SEPA Exempt (Y/N)
NIC -C7 I
Date
15 Type Work '*.❑ Bldg
0 Fire
0 MH
0 Demo
❑ f1�w
Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work
ALL 1@-O 0 LT( 060
10 Applicant Name
RIci-(AAV 6, WA6N -''il
Street Address
5.){a(5 4-}oc.e0w
11 Zip
99a0X
City
SPDKI-ti#
State
iwA,
Phone
(*'?) qa6-?o75
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
Environmental Health
W. 1101 College
Room 200
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
❑ Commercial;
❑ New Construction;
O Additional structure;
idential
Bldg alteration/addition
APPLICATION #
Rele. , :V
Release
w/cond 1
Hold 2
•
J6 III
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; 0 Residential; 0 Flood Plain;
N.811 Jefferson ❑ 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'
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
1
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