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1985, 12-13 Permit App: 00009156 Pole BarnBUILDING 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 ner's Name (last) / (first) (m) Department Use Only -7 ;y` J - �. Comm I 2 Project Address (not Mailing Address)�cr Road Name Space Zip ?_/ — i2G° C d A 3 City/Community L /, LY! / e-- 1 i State/ G -6J G%� Subdivision/ Plat Name �, V) I n vI V 7 r 4 Assessor Parcel No. /�� (1 1 Lot I Block * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. # Zone A / , Project No. 6 Dwell* j No. of Buildings Sq. Ft./Acre Depth i 3f2,961 Frontage ©©i -Front 7 Set Back -Front o 1 (L)S-1 (R)S-2 I Rear Census Tract I Module No. Initials i NI0N\01. 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm Name BRANSON UNITED Street Address Zip S. 11524 SP?. SPOKANE. WAS Gty nLD05 . �` t. State L Phone ( ) Contact Persons ® ji .r/�ii.z. ate License No. _X if- 4 N--. c r - 9- / 1(1- /C Phone If different than above (6 ei) Q;22 — ._2 2 9 /_ 8 Owner/ ent (if different than #1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (YIN) Other (Y/N) I SEPA Exempt (Y/N) Date 15 Type Work ❑ Bldg ❑ Fire ❑ MH ❑ Demo ❑ Add/Alter ❑ Replace ❑ Move ❑ Other 14 Describe Work /j �� /Y.l��- -- %. -D X &'' 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 a m c DEPARTMENT APPROVALS • 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold 1 nis is nota Permit Application Type (Standard unless otherwise indicated) (Indicated approvals required in either "release" or "release with conditions" space prior to permit issuance.) ❑ • Fast Track Early Start Release Releas w/cond 1 Hold 2 Environmental Health ❑ Commercial; ❑ Residential W. 1101 College ❑ New Construction; ❑ Bid alteration/addition Room 200 ❑ Additional structure; j'd j 1, ',j' I 15 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 ❑ new access/approach; 0 fence; I I 0 road improvements Conditions/Comments• Utilities: N. 811 Jefferson Conditions/Comments• Other: • Plan Exam Fire Prev. Conditions/Comments. iInformation ❑ 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 MM. MEMMEMMEMMEMMIMMEMWRIERM IMMIMMIMME MIMS mommilimmimmimmimillmnsmommummumm 1 EIVIEMIERAMME iiiIMMERIM Impaunsuraramas its...orm .. mummommommimmimimmorsimmg_mmmom mmumsommummommommmumwmmmmemommrmmummm muniormimmommummErnmownwreo EWE= miligluis iT MiiilliMMIA iIiiIIIIIlIuiF 11111111111 11111111 III i 1 A