1985, 06-28 Permit App: 00006153 Addition BUILDING 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 Nae (last) �� (first) (m) Department Use Only
/ J._)8' fi /�i AO 6-1-1,9 `J Fes. Comm
2 Project Address(not Mailing Address)or.Road Name Space Zip
' ' 1 zb Rx ' ) 79Z;4,
3 City/Community State Subdivision/Plat Name
5-i- i e,+•9 5\J & W 1,4 Al a i-J PJ L i9,27) t>7 16 l o y.j 2T fI)j>r7 ,
4 Assessor Parcel No. Lot Block
--)_7 S 44-1 , O 7 O S` 5' 7 * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone Project No. 5
6 Dwell# No.of Buildings Sq.Ft./Acre DepthFrontage
• 1 ( '31 i i 8 1
7 Set -Front I(L)S-1— (R)S-2— 'Rear— Census Tract Module No. Initials
'• M6 ,J0 r .
* 16 Architect Firm Name Street Address *
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
Zip City I State Phone
( )
Contact Person License No. Phone If different than above
( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
/ ( ) 9 7-<-/- 5 I
12 Review Required Plan Check(YIN) Other(Y/N) SEPA Exempt(YIN) Date
15 Type Work J4 Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo X Add/Alter ❑ Move
14 Describe Work
2D 4 p690100 p496\1, 411466
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
Iltc _ 2 4o,
POCK –7 f3 0 '
DEPARTMENT APPROVALS
This is nota Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.)
Fast Track
Early Start Release
Release w/cond 1 Hold 2
fe
Environmental Health ❑ Commercial; ❑ Residential 4111b7W.1101 College 111New Construction; ❑ Bldg alteration/addition �►
Room 200 10 Additional structure ptg----**
�,%/
APPLICATION# Nictv
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; 0 fence;
❑ Other
Conditions/Comments:
C Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N.811 Jefferson ❑ drainage ❑ new access/approach; 0 fence;
❑ road improvements
Conditions/Comments:
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
Plan Exam
Fire Prey.
Conditions/Comments:
a
c
c LI
Project Representative Telephone
Agencies Performing Special Inspection:
Y o 1'
f0 �
~ E 2.
1 O
co u_
C
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
•
Spokane County Assessor
Courthouse, W. 1116 Broadway O K A First Class Mall
Spokane,Washington 99260-0010
y � U.S.POSTAGE
ASSESSOR'S NOTICE OF CHANGE OF VALUE PERMIT G
R.C.W.84.40.045 �j. S`Z`'
,19
This value change effects the 19 86 tax.
Parcel No. 27544-0905 Appraiser 00 Book 00807 OUTSIDE
05/05/85
• .,1 ASSESSED VALUE IS 100% OF TRUE AND FAIR VALUE
LAND
OPEN SPACE DES. FOREST LAND MARKET VALUE
XXXXXXXXXXX XXXXXXXXXXX XXXXXXXX XX
OLD VALUE
NEW VALUE
M
C:
TOTAL TAXABLE VALUE C r021326
r�M M MTG
LAND BUILDINGS TOTAL
7,700
OLD VALUE
NEW VALUE 11 , 500 41,2J
COUNTY ASSESSOR GEORGE BR I TTON
J
4
II in the , COUNTY OF SPOKANE, AND STATE OF WASHINGTON..;
i� v..�.n s s _ ,. Y r‘r....-. ,�,., Survey-f of Loam purposes.--.�–'' .
.... y. srs+ O+'-.s-...-..._'C�.2rge..� Ae..,} D .... �• d'r.Ciestr+�-rh«:«+. •' - - 'E
t�.y I
S Ip 1" -'20 Ft p ° ? linrt oy d• 1Vrmn wr 10 196,r; ;�:
'' Therebyy certify that I 3u veyed:the above,described property and that I find the improvements to
be on:the premises in question and that theydo not encroach on the property lying adjarkat�thereto--
r ,` B%CEPT.
NO improvements encroach on these premises—Except: £ az:, ...,,
OWNER or BUYER SARGENT & FLAGAN
I .. ;-Registered Land Surveyors
!I Douglas C. DeAndre I'honc HL' 7-6150
East 13626 Redlin Avenue
*
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