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1984, 06-18 Permit App: 00000703 StructureBUILDING 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) Department Use Only Ras• Comm b /y 2 Project Address (not Mailing Add SO or Road afne Space �hc� Zip ��2�6 So i1 & n ,Dr 3 Gty/Community State ,�f Subdivision/ Plat Name J y 5- T ' , " r tA • 4 r Parcel Nn y of 5' Block r% 2� - // P ,t ,t ,t DEPARTMENT USE ONLY 5 Sic Code Zone Act. # Zone Project No 03 6 Dwell # No. of Buildings Sq. Ft./ Acre Depth Frontage 7 Set Back -Front (L)S-1 (R)S-2 Rear Census Tract Module No. Init'als 16 Archit t Firm Name fir,' - SIV Street Address .a �a mss, c 5` y Zip City State Phone 201? ( 5©g) c -E R7 6 O C3 Contact Person c S Pr/N g Phoneif different than above ( ) 5a C_ Contractor Firm Name/ Dov --f—z" Street Address r. 0-�e� c Zip � c y Gty Sic 'a State Phone 8 7 Phone If different than above Contact Person License No. 8 Owner/Agent (if different thh�.,{,#1 above) 1 Business Address r� I- et k 9 zip,D City S Q /� Q N 0 Y Y Stat` �/ n s ''t Phone �® 0) 4- 8 2_ X 7 3 7 12 Review Required Plan Check (Y/N) Other (Y/ N) SEPA Exempt (Y/ N) Date 15 Type Work ❑ Bldg ❑ MH ❑ New ❑ Replace ❑ Other El Fire El Demo ❑ Add/Alter ❑ Move 14 Describe Work 0 P71 10 Applicant Name DoH G A -lot Street Address �. s2� T' i� o(A 1*-I&Ae 11 Zip I?q 207 City S okaNe- State Phone "SO?) 49.2- 2$73 Lender N � �v e Street Address Zip City State Phone Contact Person Phone if different than above Additional Information ❑■ Application Type (Standard unless otherwise indicated) Fast Track Early Start DEPARTMENT APPROVALS This is not a Permit (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) Environmental Health ❑ Commercial; W. 1101 College ❑ New Construction; Room 200 ❑ Additional structure; APPLICATION # Conditions/ Comments: ❑ Residential ❑ Bldg alteration/addition Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/ Comments: Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; N. 811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ road improvements Conditions/ Comments: 01 Utilities: N. 811 Jefferson Conditions/ Comments: 011 Other: Al a Cn C ❑ _m U N Q. 0) c Y O E L ; o ca `c LL _ Plan Exam Fire Prev. Conditions/ Comments: Project Representative 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 Telephone Release EHold Release w/cond 1 2 V/4 I L Telephone SPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY Dear Applicant: The Department of Building and Safety has an automated building permit management system. Certain inform- ation relative to your project exists and/or will be added to the system which identifies conditions that must be met prior to, during and after the issuance of your permit. Upon issuance of the permit, the system will assist us in tracking the progress both you and this department make in completing the requirements that must be met prior to finalization of your permit. In order to complete the attached worksheet and submit application for your building permit*, the following information/documents are required: • A Parcel Number and Legal Description of the proposed building site. These can be found on your property tax statement or can be obtained from the County Assessor's Office. • A Site Plan of the proposed project. Three copies of an 81/2x11 site plan are required for most residential projects and at a minimum should include: • The scale used and a marker indicating the direction of north; • The location and name or number of all streets and alleys adjacent to the site; • The location/dimensions of property lines, easements and structures (both existing and proposed) including setbacks between buildings and from property lines; • Approximate surface elevations and/or slope (drainage) of the property; • The location of on site parking, driveways and county road approaches; • The location of proposed or existing sewage disposal system (s); • If the project is located within 200 ft. of a body of water regulated by the Shoreline Management Act, the ordinary high water mark should be indicated; Six copies of the site plan (including one 81/2x11 copy) are necessary for most commercial projects and in addition to detailing the above information, they should include: • a vicinity map • lighting • fire hydrants • landscaping • road plans • water lines • fencing • zoning action • drainage plans conditions • Working Drawings for the project. For residential projects, foundation plans, floor plans, elevations and cross sections/wall sections are usually sufficient. Commercial projects need to include structural details, electrical, plumbing, heating and ventil- ation drawings depending upon the nature of the project. Plans stamped by an architect or structural en- gineer may be required. One set of working drawings is normally required for residential projects. Two sets of working drawings are normally required for commercial projects, with the exception of food handling establishments and struc- tures located in the vicinity of Spokane International Airport or Fairchild AFB, in which case three sets are required. • An Environmental Checklist. Depending upon the nature of your project, a checklist and subsequent 15 day waiting period may be required per the state Environmental Policy Act. (The above requirements are not intended to be a complete listing of information which may be required for your project, but rather it is a general overview applicable to many projects. Please consult the Developmental Assistance Brochure or contact the particular department for more detailed information.) So that we may assist you, we ask that you fill out the worksheet side of the attached form. PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND. Upon completion of the worksheet and submission of a site plan, a Department Technician will determine what other departments must review your project. After such review, please submit the worksheet and building plans in order that we might process your application. Thank you. *Contact a Department Technician for Fast Track permit and Early Start approval information I --I r 111 All T7 --t- 7