1986, 01-02 Permit App: 00009289 ResidenceBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
/'(1-
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) (first) (m)
D & B Building., Inc.
Departmen$7 ly
Res. Comm
2 Project Address (not Mailing Address) ar Road Name Space Zip
. 3 3 D<v 0i1 1 Li SSA PIZAUE 99206
3 City/Community
Spokane
State
WA..
Subdivision/Plat
Midi
Name
one lrr3 Add i t.i on
4 Assessor Parcel No.
'11C41-21122
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act. N
Zone n1
Project No.
6 Dwell #
i1.293'
No. of Buildings
Sq. Ft./Acre
Depth
125' - 141.74
Frontage
82,p9,
7 Set Back -Front
2'
(L S-1
10'
(R)S-2
9'
Rear
45f
Census Tract
Module No.
Initials
j0 N
16 Architect Firm Name
Design Alliance
Street Address
N. 1014 Pines
Zip
99206
City
Spokane
State
wa
Phone
( 509 ) 928-7096
Phone if different than above
( )
Contact Person
Bruce Albertus
Contractor Firm Name
D B Bui ld ina . Inc,
Street Address
2018 R 1st. Ava TTni 1-. T1
Zip
99206
City
Spok
ne
State
wa
Phone
(09) 926-0755
Contact Person
License No.34i
Phone if afferent than above
( )
Bobbie Swanson
DB -Bu -I-24313
8 Owner/Agent (if different than 81 above) q / 3o/13 c.,
Dr38U._ 4 —4 21313
Business Address
9 Zip
City
State <3 f z j/8 C.,
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/ N)
SEPA Exempt (YIN)
Date
15 Type Work C2' Bldg
SF Residential ❑ Fire
❑ MH
❑ Demo
X New
❑ Add/Alter
❑ Replace
0 Move
❑ Other
14 Describe Work
Rancher, slab on grade, double car garage
10 Applicant Name
D & B Building, Inc.
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
i2.� v ------./-1F Y/jc r i F l L iC£nrse No
71F-`/1' _ ClAr'
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;
❑ New Construction;
❑ Additional structure;
APPLICATION #
❑ Residential
❑ Bldg alteration/addition
I Release
Release w/cond 1
Hold 2
Planning/Zoning:
N. 721 Jefferson
Conditions/Comments.
❑ Commercial;
❑ Setbacks;
❑ Cert. of Exemption;
❑ lot w/d; ❑ lot size;
❑ CU, variance, zone change; shoreline;
0
❑ Frontage;
0 use/zone;
fence;
❑ Other
Engineers:
N. 811 Jefferson
Conditions/Comments•
O Commercial;
❑ drainage
O road improvements
❑ Residential; 0 Flood Plain;
0 new access/approach; 0 fence;
7-7(64
Utilities:
N. 811 Jefferson
Conditions/Comments•
Other:
Plan Exam
Fire Prev.
Conditions/Comments•
Project Representative
Agencies Performing Special Inspection:
1
Telephone
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold