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1984, 04-20 Permit App: 84A-3632 Residence 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 Name (last) (first) (m))) Department Use Only /7/ r^.t _SO L 1,1 / t Res' Comm 2 Project Address(not Mailing Address or Road Name Space Zip R i d 0 I ( r. 1q l 1,eiu..e,c._•' 3 City/Community State Subdivision/Plat Name sp(29k. w 4 Assessor Parcel No. Lot Block Q -y/�I — O'�f 5 Sic Code/�j * * * DEPARTMENT USE ONLY * * * Zons_C Act.N Zone Project No. ' 6 Dwell N No.of Buildings Sq.Ft./Acre Depth Frontage I 1 7 Set -Front I(L)S-1 (R)S-2 Rear Census Tract Module No. Initials ii * 16 Architect Firm Name Street Address * Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contractor Firm/Name Street Address PQ ex. I e , airj. W�i Zip (J City State Phone . 9-90t c 7 ,...5y()4c4.---Q k.---- ( ) Contact Person License No. Phone If different than above ( ) 8 Owner/Agent(if different than 01 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(Y/N) Other(Y/N) I SEPA Exempt(Y/N) Date 15 Type Work f, Bldg ❑ MH E New ❑ Replace ❑ Other ❑ Fire ❑ Demo X Add/Alter ❑ Move 14 Describe Work SPP 1 a IJ o- 6AYLA6, 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 o f t)S ON /0 x 2 y c c9,-L c crn i /.c ,4-e Gti ,.c cc 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 Environmental Health E Commercial; E Residential W.1101 College E New Construction; E Bldg alteration/addition Room 200 O Additional structure; APPLICATION# Conditions/Comments: LI Planning/Zoning: 0 Commercial; O Cert. of Exemption; D Frontage; N.721 Jefferson 0 Setbacks; lot w/d; 7 lot size; 0 use/zone; . 0 CU,variance,zone change;shoreline; E fence; 0 Other Conditions/Comments: Engineers: 0 Commercial; 7 Residential; E Flood Plain; N.811 Jefferson 0 drainage El new access/approach; 0 fence; 0 road improvements Conditions/Comments: Utilities: N.811 Jefferson Conditions/Comments: LI Other: LI Plan Exam Fire Prey. Conditions/Comments: c —LJ Project Representative Telephone a) Agencies Performing Special Inspection: 1. 2. "i7) 0 3. 1 indicate above or attach conditions relative to final as built approval 2 indicate above or attach reasons for hold STATEMENT RALEIGH D. PETTY GENERAL CONTRACTOR '��y�1 I``, SPOKANE8921NORTH, WASHINGTONLEHMANROAD 99207 � 3 (50 9) 924-0773 ‹, )� CIS arc �q • syr 1 1� y S "\L