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1986, 06-12 Permit App: 00011556 Garage(THIS IS NOT A PERMIT) BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND COMPLETE IN INK (Please return this original and your building plans to the Department of Building and Safety) Or-WHUCU HriCFiO Hr r- F -Un UCr,Nr1 11VICI14 1 HL UOC Project Number / 1,5,56 Owner's Name LAST FIRST MI Project Address (Street N:V N2um Zip 161 D l 6,7 aZ7 10 Applicant Address Cit State Zip Phone Business Phone ( 1 Contractor /Agent Address City State Zip Phone Contact License Number (Required) Business Phone Architect/ Engineer City State "Zip Phone ( 1 Contact Business Phone ( 1 Lender Address City C State Zip Phone Describe Work Res. Comm. Subdivision /Plat Name/Short Plat Number t' r, Assessor Parcel Number Lot Block Plat Number ` Pertinent File Numbers Zone Comp. Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size (Sq. Ft./ Acre) Depth ) J� Frontage } Front Setback Left Setback Right Setback 1 ao" Rear Setback R/ W Width Additional Information Square Foot Z O H Q O tL Z_ O - Z J_ D ED Number of Bedrooms Building Technician Date Group Type( ` E 0 0 0 N U A DEPARTMENTAL REVIEW I certify that I have examined this application and state that the information contained in it and submitted by me or my agent to compile said appjjqation is true and correct. Approved Cond. Approval Hold Environmental Health Application N W. 1101 College Room 200 2— Planning/Zoning N. 721 Jefferson Engineers N. 811 Jefferson Utilities N. 811 Jefferson Plan Review/Fire PreventionN. 811 Jefferson Other(SEPA/Critical Material/etc.) Fast Track/Special Inspection Information Project Representative Phone Address I certify that I have examined this application and state that the information contained in it and submitted by me or my agent to compile said appjjqation is true and correct. Show on Site Pian: Lot Dimensions Existing Structures Proposed Improvements Structure Setbacks Easements Septic System (s) Water Lines Sewer Lines Fences, Welts Driveways) Right of Way Width(s) Fumes of Fronting Street Flanking Street I7 Scale: Date: Revisions: Attachments: SPOKANE COUNTY BUILDING AND_SAFETY DEPARTMENT Inter -office Communication Date_ 19- 7a 9T rme From Subje� /14-- 4P 4P C ) l C-zl 1 I o c�' C, dh J l (cl ©c �� ��� �PJYI J 7) u cs Iz To `-::k —7 Date /— � — Time WHILE YOU WERE OUT m of ` C c/ Or 'Cet- Phone Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message `ll Operator AMPAD 23-000 50 SHT PAD EFFICIENCY@ 23-001 250 SHT DISPENSER BOX Mow on bile Tian: Additional Information: Lot Dimensions Landscaping Existing - Exis g Structures Drainage Plan�-- _ Proposed Improvements Hydrants Structure Setbacks Topography qi _.+—_..._.— Easements Lighting — T Septic System (s) Signage Water linesShorelines _ , -� { 1 t Sewer Lines Ni hwater Mark - _ i2' , Fences, Wells Driveway(s) RightWidth(s)t _ , t t _ Names of i Fronting Street Flanking -- ! Street , : , • ! i • I Le al Des cn Eton i , — jjj N , _ 1 O — Q— i 1 ! �>� � F • � 1 1EIE • t # # ....................., ; e 1 I ; i r , ' { , t , 1 { L 3 3 • ! } • it 777 4-4 ILE 77 i- ,< 1 3 : • # i d f - - i . -t..." .,.. ` — t > , 1: 1 i - .. r 1 F:4 { Scale. - _ _ -:: _ # ,,: ._ _ . �, .... .�• ,. i. ,. _ �.. ; Oats _ , , , H r _ '41 C�l 7/c 7� 7� r na lL-, 4U,..e f/LC%G�/GLG(%C �✓(CGYI' /LE(�(/1 GUY17 c��cx/� — n IU I., Occivut /� � lnn ClGYI L V4 -e�ICLYI �LvI y SA Ct ll oc�z Chi G✓ � �c L � `c� � 2- e -lip cc -q v2 J - .�Z�_,e.c�y .mit d h -e c.�' h c� � c� G"_✓` .il-Q-cr'va t � 5 � �� )-- t- i�� � 0 N O H W ao 0 0 w J%0 C