1984, 11-14 Permit App: 00003343 Storage BldgBUILDING 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)
1ner's Nam (last) (first) (m)
f / f�C
(Project
Departmen yrrw Only
Fps.
Comm
2 Address (not M cling AddOss Road Name Space Zi ��T i
3f y/Community
State
Subdivision/Plat Name
4 Assessor Parcel No. )
_ 2. ` T
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone mailProject
No.
/
6 Dwell k
1-
No. of Buildings
Sq. Ft./Acre
Depth
I
S7a
Frontage
170 !
7 Set Back -Front
t✓
(L S-1 (R)S-2
13---1 l
Rear
44()
Census Tract
Module No.
Initials
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
;;ANSON UNITED STEEL RI p
Street Address
Zip
GtE. 11524 SPRAGUE
SPOKANE, WASH. 99206
State
Phone
.15-Z7.15-Z7r � )--_;a:17.,7'7
Cont
n
Licen o.
Phone if different than above
8 Owner/Age
t if different than 81 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
❑ Fire
❑ MH
❑ Demo
❑ New
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Des be Work
, 6 x 6 ‹,.. / A' . 4- -
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;
❑ Residential
O Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
d
/t -1v -kV
APPLICATION # roc c�,�i
Conditions/Comments. 1p 4.4nc. p, 1,�..eL�, 4 /
d'.(e,74.-
Planning/Zoning: ❑ 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•
Engineers: 0 Commercial; 0 Residential;
N. 811 Jefferson 0 drainage 0 new access/approach;
O road improvements
Conditions/Comments.
❑ Flood Plain;
O fence;
Utilities:
N. 811 Jefferson
Conditions/Comments.
Other:
Plan Exam
Fire Prev.
Conditions/Comments.
Project Representative
Agencies Performing Special Inspection:
1
Telephone
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
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1? -11-/ 1], Lo/99
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PFSCRIPTION
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