1985, 05-16 Permit App: 00005443 GarageBUILDING 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) Department 1�Uw&ily
Chi isty '<Oren g• �� V Comm
2 Project Address (not Mailing Address) a- Road Name Space Zip
N • .4707 /-dyer) Pd •9921 to
3 City/Community
nKdr)e.
State
VYA
Subdivision/Plat Name
Pepli s F! s Addi 1
4 r Parcel No.
Ci '5 1— l .1 U�
�C
�Act. `#
Lot
3
Block
i r a ♦ DEPARTMENT USE ONLY
5 Sic Code
Zone
Zone
5 F Project No. sem. 3
6 Dwell 0
\
No of Buildings
Z
Sq. Ft./Acre
146(")01146(")01)4q
Deptht
Frontage
1 bat
7 Set Beck -Front
(LIS -1
(R)S-2 t I Rear t
S _7
Census Tract
Module No.
Initials
3'a -
*
i6 Architect Firm Name I Street Address
Zip
City
State
Phone
1 1
Contact Person
Phone If different than above
( )
Contractor Firm Name
Street
Address
Zip
City
I State
Phone
Contact Person
License No.
Phone If different than above
8 Owner/Agent (If different than #1 above)
Business
Address
9 Zip
City
State
Phone
1
12 Review Required
PlaaCCheck
(Y/N)
Oth r (Y/N)
I SEPA
Exempt
(Y/N)
Date
15 Type Work Tr
CMtI�^P 0
Bldg
Fire
❑ MH
0 Demo
L New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe rk
6, Pro +-Co E
?4 X 3 7-
10 Applicant Name
l(d re/7 R . ahr)'5
t y
Street
N
Address
. K/07 1 -arch Rd .
11 Zip
002/40
City
Spokane.
State
VYF-
Phone
(509) 924- ,/, 4-7
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 0 Commercial; 'J' Residential
W. 1101 College 0 New Construction; - '❑ Bldg alteration/addition
Room 200 lit] Additional structure;
APPLICATION # J 3 -4 983
Release
Release
w/cond 1 Hold 2
I/ � /
a
Cond itlons/Com menta•
0
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; i❑ lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments -
0
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage ❑ new access/approach; 0 fence;
O road improvements
Conditions/Comments
0
Utilities:
N. 811 Jefferson
Conditions /Comments'
0
Other:
0
Plan Exam
Fire Prev.
Cond itlons /Com men is•
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