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1984, 07-17 Permit App: 00001246 Residence
BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDEF STAND (Please return this original and your building plans to the Department of Building and Safety) 1 Owner's Name (last) (first) (m) —8 /1 Only Department Use Onl r~ -C G5 Q t Mr Res. Comm 2 Project Address (not Mailing Address) a Road Name Space Zip Sa` L. 34tv7 46-c e, il- �c«o ggaO� 3 City/Community 5190 i.? am c_ _sots State a.wiz Subdivision/Plat Name _ I'vtx-d`tovi& 3 4 agdc1,A . 4 Assessor Parcel No. Priv . k _ vU Lot J Block `} * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. # Zane '-r(2... r(2... Project No. 1 / /S ) f Vs�� 4 6 Dwell N l No. of Buildings 'Sq. 1 Ft./Acre Depth Ips Frontage` go' 7 Set Bads -Front (L)S-1 (R)S-2 Rear Census Tract 1 Module No. Initialsalq " 16 Architect Firm Name NbtoQ Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Contractor Firm Name A2 *2) %.,k 2 Street Address Zip City t_ State Phone ( ) Contact Person License No. Phone if different than above ( ) 8 Owner/Agent (if different than #1 above) Business Address r 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 Or New ❑ Add/ Alter E Replace ❑ Move ❑ Other 14 Describe Work C olt s•A.c tk-\ a Sc,t .\ e -k�'' ` \ \ -(' e g. d e ,4c Q 10 Applicant NameSt .._ \C' rGS t Addr ss o , 0X ( 33 a3 11 Zip ggar3 City 510e, (. a -,,LQ State WU-S\'1. Phone _ ( ) . *-©S-n f Lender Aiovk Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information 1 MT. s i ii =,' flECEIVE tki--64(12 • ":z1 X 21= ? (p JUL r1984 hECEIVE=. o 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; O New Construction; O Additional structure; O Residential D Bldg alteration/addition APPLICATION # Release Release w/cond 1 Hold 2 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; O CU, variance, zone change; shoreline; ❑ fence; O Other Conditions/Comments- 1/Engineers: onditions/Comments• Engineers: 0 Commercial;�sidential; 0 Flood Plain; N.811 Jefferson ❑ drainage fd 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 conditionsrelative to final as built approval 2 Indicate above or attach reasons for hold 1 Jim Brose P.O. Box 13323 Spokane, Washington 99213 Phone 326-0501 Property Address: South 3617 Loretta Drive Spokane,Washington 99206 Legal description: Lot 8, Block 4, M dilome Third Addition 901 111 2f- 35' 28 151 Two—Car Attached Garage Loretta Drive Concrete— drive 38' 241 1 2 5' Scat e 1 / = ZOO