1984, 05-18 Permit App: 00000286 Garage • BUILDING 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) I Department y�Only
` � s L\�Z lbs.. ✓ For;m
2 Project Address(not Mailing Address)or Road Name Space Zip
4-1- /Z .C1 E - ),_:\bil
3 City/Community State Subdivision/Plat Name
4 Assessr ,I�\ _ Lot oBlock ` Ate"jn�
•
v
fJo S54 —cm-7-z_ * * * DEPARTMENT USE ONLY * * *
A 5 Sic Code ' Zone Act.# Zone Project No./-� /�
6 Dwell# No.of Buildings Sq.Ft./Acre !//DDepth �j Frontage
fr.��// 1 2- lb"z Get
"/ 7 Set Back-Front I(L)S.1 i (R)S-2 l Rear , Census Tract Modul�No. 'tials1
* 16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone If different than above
( )
* Contractor Firm Name Street Address
Zip Cl State Phone
Contact Person License No. Phone If different than above
rA-o_I FC. 7 T6) I,--Z- ( )
8 Owner/Agent(if different than#1 above) e-2,Z ,o 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 ❑ MH II/slew ❑ Replace 0 Other
0 Fire ❑ Demo 0 Add/Alter 0 Move
14 Describe Work
'C1 rGNeO CaIfsle_sct%
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
DEPARTMENT APPROVALS
This is not a Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.) /
O Fast Track
1:1Early Start Release
=s w cond 1 Hold 2
Environmental Health ❑ Commercial; Residential
W.1101 College ❑ ,New Construction; ❑ Bldg alteration/addition
Room 200 Additional structure;
APPLICATION#
Conditions/Comments:
O Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson 0 Setbacks; ❑ lot w/d; 0 lot size; 0 use/zone;
❑ CU,variance,zone change;shoreline; 0 fence;
❑ Other
Conditions/Comments:
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N.811 Jefferson ❑ drainage ❑ new access/approach; 0 fence;
❑ road improvements
Conditions/Comments:
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
•
El Plan Exam
Fire Prey.
Conditions/Comments:
a
C
c❑
Project Representative Telephone
0. Agencies Performing Special Inspection:
O c 1.
Y
U '
f0 T6
E 2.
co in o
uc
3.
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
ROOF TRUSSES, INC.
Project 1.0
LT. FORM 15
7311 EAST NORA
SPOKANE, WASHINGTON 99206 PHONE: WA 4-1161
By Job No. Date Sheet No.
3 i.• .
frA r‘ AS9 7,309 E LIBE,e_ryi
„44.
\.,
...,,._ . 5 RD KAOT
I -' 2 i \- %10
7
-7
is
\\ {
.
(.:', ,
.
r 4
4
?\ ..
v u
D : zz
I
U
4
Liaeery
}
,
i f