1986, 01-07 Permit App: 00860005 Duplex(THIS IS NOT A PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
C(2
J1-1AUtU Ht1tHJ Hilt h0t1 Utl-HI1 I IVIti'l I HL UJt
Project Number -
--
Owner's Name LAST FIRST MI .
t
F U
c.5 -e ;tap
Project Address (Street Name & Number)Zip
f- e,-//5-) 7 /»/t2 C6uRT S749,€-,vfe, (L)4. g9�0t
Applicant
a).0 g//9-,0 o/ &D.
Address
`(1 7/ 7 4 (Z,Le1S,
City
DkaA r°
State
Zi/ rA,
Zip
.922'6-'
Phone
(�9 yah a.�9a
Business Phone
( I
Contractor/ Agent
LOC/1//-)tvb C'o.
Address
,5-- 7/ 7 /J//f/&s /'j
CityState
SPOKAA.er
(,UAs/1.
Zip
99ac 6
Phone
(S9) gay 076'92
Contact
F= • U. Se i Py6
License Number (Required)
W ok Pi_ e. #
/6 9/0 9
Business Phone
(�. )�i'a f as 9z
ArchitectlEngineer
Address
City 1 State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
Describe Work
P u PL4 CI -0 F—
Res.
V/
Comm.
Subdivision/ Plat Name/Short Plat Number ! / /
SYLUi'R L�L')UT K/�'ddi T 'DAJ J�OT 1°1-»r Fc.6 X77
Assessor Parcel Number
67.'/1-- c.?cd'
Lot
i.44ee/ 8
Block
Plat Number
T3 -c2,47
Pertinent File Numbers
ZoneF 111-•
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
/
Lot Size (Sq. Ft./Acre)
Depth I
k19
Frontage i
q4.I1
Front Setback t
30
I Left Setback )
� (0
Right. tback)
ld
Rear Setback
—
Additional Information
-rt. i -
IDEPARTMENT USE
Square Footage
inilF - I7 v
06 i 05
PECr_= 32o
Group
-3
Type
\J K)
Building Technician
\10 I\1 M.
Date
I-7-8(-.
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health Permit Nu—}mbeerjS (Z[J'r/�'Q K �• (
Room
�'
1101 college d�l�e / !1 '
Room 200
(BY £/
Planning/Zoning
❑ N. 721 Jefferson
Engineers
❑ N. 811 Jefferson
Permit Number
FAA-- Do 9'
Utilities
❑ N. 811 Jefferson
Plan Review/Fire Prevention
❑ N. 811 Jefferson
0
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent Is true, correct, legal, and binding__.-- � y/
/4/ 41:1:74.1 Date ( 7 o r
Owner's Signature
PARCEL NUMBER:
INFORMATION WORKSHEET
01S-041- &3o(
STREET ADDRESS:
S-F9,r-/1 M$44sFie*c.D
CITY/STATE/ZIP: SPogt4/IE, Wi4, 90 Ad !1—.
SUBDIVISION: SNo*r 12J407- t2- 297
aeEt_
BLOCK: LOT: " ZONE:DUPLE DISTRICT:
LOT AREA:/y7L,p F/A:gagE6, WIDTH: DEPTH: R/W:
# OF BUILDINGS: 1 # OF DWELLINGS: % WATER DISTRICT:WA7z'r0 Disc ''3
OWNER: ,€jti SE/too
MAILING ADDRESS:It /AP/2.- 406
PHONE:
CITY/STATE/ZIP: SPO,stilir,
CONTACT: VINOE SAF/AO,
99.204.
PHONE: -9 - 726Z
SETBACKS: - FRONT: 3o 1LEFT: to RIGHT: /D REAR: to
PERMIT USE: en O Pt.EX
*RRA***********************************k********A****kik***int***************
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:CCo!-Ccl b L L= L, C /Vo M / tiz e/ 9 O
CONTRACTOR: ttOLPL4NJb Co PHONE: 9 -fxQ- d'ra
MAILING ADDRESS: £_ 90/4 _0A/D/f/14 So ,re Al/ca
ARCHITECT/ENGINEER: PHONE: - -
MAILING ADDRESS:
NEW:X REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: j OCCUPANT LOAD:
BUILDING DIMENSIONS: .?tf X 7 0
BUILDING HGT: STORIES:.5,E,
(WIDTH X DEPTH) SQ. FT.:447e)
REQUIRED PARKING: 44 # HANDICAP: rQ SEWER (Y/N): N HYDRANT: u
JOB STREET
1 •
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
ADDRESS: £ -gins--/7 M 4 A45F/CLD
CITY/STATE/ZIP: SPakeidE A 99a2/a. PARCEL NUMBER:
OWNER: i! // SE,',°P
PHONE NUMBER:
oicYW —not
9.22-/6ep -AltAt<
- rfooylE
MAILING ADDRESS:L- 90/4 ,tib,nsin Jo ire ti Aro SOo.ieeld 99a/2.
CONTRACTOR:
(Street)
MAILING ADDRESS:
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
(Street)
(City/State)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER OF
FIXTURES
X EACH
FIXTURE
= AMOUNT
(Zip)
TOILETS
SINKS
SHOWERS
BATH TUBS
KITCHEN SINKS
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIC WATER HEATERS
FLOOR DRAINS
FLOOR SINKS
BAR SINKS
ROOF DRAINS
LAWN SPRINKLER
SEWAGE EJECTOR
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
4
2
j.
2-
2..
x $6.o0 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
a4 °
.T4 °-
_zit al
/z
09
%% 02
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
SUBTOTAL
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: t. 674/5 "---/7 M0-a/SFiEL0
CITY/STATE/ZIP: $0640E tt .L 9,91„2/2_- PARCEL NUMBER: es75-44/- a 8
OWNER: F. V. S E/"/
PHONE NUMBER: 9.281.756
MAILING ADDRESS: S- O/4 - /N'O/Hdf7 ,Su/TE /at SPokni4E
(Street) (City/State)
CONTRACTOR:
MAILING ADDRESS:
LICENSE NUMBER:
PHONE NUMBER:
(Street)
992/2_
(Zip)
(City/State)
(Zip)
MECHANICAL
DESCRIPTION
WORKSHEET/FEE SCHEDULE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000
HEATING EQUIPMENT +100,000
GAS PIPING (EA OUTLET)
REFRIG 1-10014 BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
BTU
BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,75014 BTU
HEAT PUMP & AIR CONDITIONER
HEAT PUMP & AIR CONIDITIONER
HEAT PUMP & AIR CONDITIONER
NEAT PUMP & AIR CONDITIONER
NEAT PUMP & AIR CONDITIONER
VENTILATING FANS
0-3 TONS
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12'
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG _
14ISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNILISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
PTN. OF HOOD)
x$10.00 =
x 25.00 =
Z x 10.00 =
£ x 12.00 =
x 15.00 =
7 x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
eo
e^
NOTE: MINIMUMJ�EE IS $35.00
SIGNATURE 2Le
Spokane County Department of Building and Safety
Wn't 11111 Rrnndwnv Avenue Spokane. WA 99260 (509) 456-3675
SUBTOTAL
$ 6,00
PLUS: PROCESSING FEE
4 $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
ea
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