1984, 07-19 Permit App: 00001276 CarportBUILDING 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)
- /— C A, C /7. / \C'L, C, V
Department Use Only
Fes. Comm
2 Project Address (not Mailing Address) or Road Name Space Zip
3 City/Community
S �a � w `
State
1�ii -S
Subdiv on/ Plat Name
eves c
4 Assessor Parcel yo.
/�� O`�ODEPARTMENT
Lot
Block
USE ONLY
ne/Act. ff
Zone Project
No.
p
No. of Buildings
Sq. Ft.IAcre
Depth
Frontage
t (L)S-1
(R) 2
Rear
(gnus Tract
Module No.
Initials
m Name
Street Address
city
State
Phone
Contact Person
Phone if different than above
Contractor Firm Name
Street Address
Zip
City
State
Phone
Contact Person
License No.
Phone If different than above
8 Owner/Agent (if different than k1 above)
Business Address
9 Zip
City
State TFh�7
12 Review Required
Plan Check (YIN)
Other (YIN) SEPA
Exempt (YIN)
�7
Date
15 Type Work El
❑ Fire
El
11 Demo
11New
❑ AddlAfter
11Replace
El Move
El Other
14 Describe Work
1
s i & C' e ,,Sf-lig- ' r�
10 Applicant Name
C ,:=
�. �z_ r_ G
Street Address
1-5-. 4 � 3 rt
11 Zip
f Z Z_.
City
State
Phone
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone if different than above
1 )
Additional I nformatioh
DEPARTMENT APPROVALS
Indicate above or attach conditions relative to final as built approval
Indicate above or attach reasons for hold
Application Type
i his is not a Permit
❑
(Standard unless
otherwise indicated)
Fast Track
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
❑
Early Start
Release
Release w/cond 1 Hold 2
❑
Environmental Health
W. 1101 College
Room 200
❑ Commercial; ❑ Residential
❑ New Construction; ❑ Bldg alteration/addition
❑ Additional struct re;��
APPLICATION #
Conditions/ Comments:
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 F-1new access/ approach; ❑ fence;
❑ road improvements
Conditions/ Comments:
❑
Utilities:
N. 811 Jefferson
Conditions/ Comments:
❑
Other:
❑
Plan Exam
Fire Prev.
Conditions /Comments:
Project Representative
Telephone
Agencies Performing Special Inspection:
C
O
1.
E
0
2
C
3.
Indicate above or attach conditions relative to final as built approval
Indicate above or attach reasons for hold
SPOKANE COUNT" PLANNING DEPARTMENT
APPLICATION FOR DMINISTRATIVE ACTION
Date:�it% `jam application No. 3V 8T
Name of Applicant: .To OK6 4<1 J�/Ltit
Street Address of Applicant: ,S, Z 3 A0
City: _�,��k State: /,Q A, Zip Code: BIZ Tele. No. gZ.la 36
Request (Cite Ordinance Section) : �a,) LZzz40 1, &&O w
ZI --' -:Z // >6 ;-,,4 a,04Z%z��A44 , 6dbW-1� 7�6 1)eee
7
Legal Description of Property: X o 1
APPROVED BY:
TITLE:
DATE:
FSR OFFTC.F W1 F
EAssessor's Map Attached
❑ Copy of Plot Plan Attached (If Pertinent)
3s/
Pav�r is k %,