1985, 04-12 Permit App: 00004920 ResidenceBUILDING 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)
(last)
Department Use Only
, /
�/ �u �l� ( G�'`r ['��A'tS l G
Res. Comm
2 Project Addre (not Mailing Address) or Road Name Space Zip
g- 7 % G S '2-2-7 ..-).,c//,---/4
3 City/Comm ity
s -Z)4-
State
11,62,,t/
Subdivision/Plat Name
U /Pc// J 40 G9,(2
4 Assessor Parcel No.
_7 s 1' 2 _ !/ (`/
Lot
Block
,t ♦ ,t DEPARTMENT USE ONLY ,t* ,t
5 Sic Code
Zone Act. #
Zone ^ -
Project No.
6 Dwell #No.
F7�
1
of Buildings
'
Sq. Ft./Acre
Depth (
11
Frontage-
liV1
7 Set Back -Front t ((L 1 i
D'
(R)S-2 r
3f%
I Rearr
Ir '_11
Census Tract
1 Module No.
Initials
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
CA-9o�Zy 1i= `P.0-,r/se$.. Vic_
Street Address
/0, 13,E /37/7
Zip /
CI
State
Phone
Contact Poison
/ 5 6-,/f
License No.
C,110 0 2 /' /I/ 1.-
Phone If different than above
( )
8 Owner/Agent (if differenan #1 above)
Business Address
9 Zip
City
State
Phone
( 1
12 Review Required
Plan Check (Y/N)
Other (YIN) [sEemPtCY/N)
Date
15 Type Work Bldg
0 Fire
❑ MH
❑ Demo
New
0 Add/Alter
0 Replace
0 Move
L
0 Other
14 Describe Work
1 IA).) 6FA--r240,6
10 Applicant Name
Street Address
11 Zip
City
State
Phone
1 1
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( 1
Additional Information
S AR- 17 ?.o • i 11(n u 114
IX f : gOdrb 91
6,k S.
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
Conditions/Comments.
❑ Commercial; 0 Residential
O New Construction; 0 Bldg alteration/addition
O Additional structure;
APPLICATION # fS 4/
•JO° - — XW-0 •
Release
Release
w/cond 1
Hold 2
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; ❑ use/zone;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions/Comments.
Engineers: D Commercial; 0 Residential;
N. 811 Jefferson 0 drainage 0 new access/approach;
O road improvements
Conditions/Comments.
O Flood Plain;
O fence;
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 conditions relative to final as built approval
2 Indicate above or attach reasons for hold
FULL REAL ESTATE SERVICE
QUALITY CONSTRUCTION • LAND O'EVELOPMENT
TEL. 922-2200
LEGAL . .EZO
Tf" /✓_ 2•31.7 i9rvo Eac€rr -
47vC . ,Qooisicw /17612497- 400
M' aeAcs /s/ /.f4 /711 /77
6 Coc.w.,-j
o
i�l �Ii
•
Yj •
-rEaPIwIses
N. t,06 PINES ROAD • SPOKANE, W . 9920.
JP
1,777*
P,ed viol
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/f
..7r/S r,
ADDRESS: PROJECT #:
General -
❑ Ownership Health
❑ Applicant Increased Lot Coverage?
*Contractor Addition Bedrooms/
Fixtures?
❑ Architect Change of Use?
New Septic?
❑Address -
pfLegal Description
Parcel Number
Plannin
Unplatted Property?
Lot Depth: Width > 3:1?
(Less than 10 acres)
Lot Depth: Width > 4:1?
(10 acres plus)
% Zoning Lot Size Less than Minimum?
Site Plan Segregation of Platted
Property ?
❑ Plat Map Setbacks Less than Required?
❑Permit Description - Frontage less than Required?
likTlans Not a Permitted Use in Zone?
Completeness Rezone, Conditional Use,
Variance Involved or Required?
❑ Square Footage Commercial Use or Home
Occupation?
❑ Occupancy Group 8 Type More than One Residence?
❑ Departmental Releases Adjacent to a Required
and Conditions - Shoreline?
En•1neerin
New Access/Approach?
REVIEWED BY:.
Private or Unmaintained
County -Road?
Se•a
Underground Tank Over
10,000 Gallons
Commercial Building Over
12,000 Square Feet?
Over 20 Dwelling Units?
Over 40 Parking Spaces?
Agricultural Building Over
20,000 Square Feet?
Landfill or Excavation Over
500 Cubic Yards?
Critical Material
Designated as a Critical
Use Activity?
Yes No N/A
DATE: