1986, 01-13 Permit App: 00009381 Pole 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)
's (las 7-'11:2.4) first) (m) Department Use Only
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Ll /��u Li^� ���L�i ,YZ d $Yl� Fps. Comm
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/ 2 Project Address (not Mailing Address) cr Name Space Zip
3 City mmunity
State
LC)4---
Subdivision/PlatName
0.i la�p�-rItA AiII- L- q L / Y/
4 Parcel No. 1
52�_ "-6c1. 9
Lot
Block
* * ,t DEPARTMENT USE ONLY
5 Sic Code
Zone Act. M
Zone
Project No.
6 Dwell fiNo.
I
of Buildings
Sq. Ft./Acre
Depth t
138
Frontage
obi
7 Set Bads-Front(R)S-2
�-(1��ftN6 I (L)S-1
y
�0
Rear
Census Tract
Module No.
Initials
f ,(UN oc) .
16 Architect Firm Name
I Street Address
fl
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
BRANSON UNITED STS'" 9LDGS.
Street Address
if 524
Zip
SPOKANE, WAST-;,
'F�
;9206
State
Phone
( )
Contact Person
Qt/IL A .4,
License No.
/5 !Zl- /- q _/'
Phone if different than above
(q,k) P-.a'2G
8 O r/Agent if different than #1 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 __J-"8idg
❑ Fire
❑ MH
❑ Demo
12 --NOTA/
❑ Add/Alter
E Replace
❑ Move
❑ Other
14 Describe Work
42q 41x9 �z�
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
c
To
0
O.
CO
U
co
CO
DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Application
This is not a Permit
❑
Type
(Standard unless
otherwise indicated)
Fast Track
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
❑
Early Start
r
Releaser
Release
w/cond 1
Hold 2
Environmental
Health El Commercial; ❑ Residential
W. 1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200��
❑ Additional structure;
/ • g()
i• C�(}�
APPLICATION # 1 (6S- !J
Conditions/Comments.
•
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
0 CU, variance, zone change; shoreline; 0 fence;
0 Other
Conditions/Comments•
❑
Engineers: 0 Commercial; 0 Residential; ❑ Flood Plain;
N. 811 Jefferson 0 drainage ❑ new access/approach; 0 fence;
❑ road improvements
Conditions/Comments•
❑
Utilities:
N. 811 Jefferson
Conditions/Comments.
❑
Other:
•
Plan Exam
Fire Prev.
Conditions/Comments•
Project Representative Telephone
Information
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
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