1985, 03-28 Permit App: 00004675 PoolBUILDING 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)
LDepartment Use Only
r/"
(i'.r�/ �rrt,,,,,-4-�.
Comm
2 Project Address (not Mailing Address) cr Road Name Space Zip
8; / o 5-71° A /r/9/1/
3 City/Community
5/4704? tier
Stale
1.1/4
Subdivision/Plat Name
5.104_ /5T a-X.C.
4 Assessor Parcel No.
ill I_ ueor
0C-411
Lot
c
Block
1
t r r DEPARTMENT USE ONLY* * *
5 Sic Code
Zone Ad. M
Zone ' 14
Protect No. 'I{
- (�
6 DweII 0 i
No. of Buildings
-Z-
Sq. Ft./Acre
Depth
31(0
f
Frontage
15o1
7 Set Bads -Front
ILS -1 1
IN co -5-7_
(R)S-2 Rear
—
Census Tract
Module No.
InitialsFle2
J U 0 M,
16 Architect Firm Name Street Address
-4lite el, / Poo/5 3—/ro /^/. ,rR>yit
Zip
992o1
City
sgo%4.-ue '
State
w.¢.
Phone
' (SJff ) 989-5-47y
Contact Person
O w*//r 4
Phone If different than above
( )
Contractor Firm Name
-r/7P,R/.0/ /90o7S
Street Address
375—o vv. Fwdy/J-
Zip
9920—?
City
S�i�i9�d
State
till"-(SoC)
Phone
e/.89-r'c?es
Contact Person
,?/2 4.9/j 4
License No.
IM PE1 O 7.77PT 233-0'
Phone if different than above
( )
8 Owner/Agent (If different than 01 above)
Business Address
9 Zip
City
State
Phone
12 Review Required
Plan Check (YIN)
Other (Y/N) I SEPA Exempt (Y/111)
Date
15 Type Work 0 Bldg
0 Fire
❑ MH
0 Demo
0 New
0 Add/Alter
0 Replace
0 Move
is, Other
14 Describe Work
?N 3-t,9// s w; Mr7 i •✓g /'o a l
10 Applicant Name l
Street Address
11 Zip
City
State
Phone
I )
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 not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health 0 Commercial; 0 Residential
W. 1101 College 0 New Construction; 0 Bldg alteration/addition
Room 200 0 Additional structure;
APPLICATION # ,8D `� ur99s
Conditions/ Comments.
Release
Release
w/cond 1
Hold 2
egir
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;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions/Comments
El
Engineers: 0 Commercial; ❑ 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-
El
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
'IMPERIAL POOLS, INC.'
N. 5150 FREYA
c5POKANE. WA 9-.'207
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