1985, 01-03 Permit App: 00003839 Siding, Soffit, Fascia , ,'� PERMIT APPLICATION WORKSHEET
"' DEPARTMENTOFBUI RING
„ Sk ' : . Level,Mu••-'*al Building
W.808 Spo'' - .11s Boulevard ^, 0 31
Spoka - ashington•• i -
o• 456-3240
OWNER'S NAME (last) (first) k (mi)
PROJECT STRE ADDRESS PARCELINUMBER PLAT NAME/NUMBER /��7 yq
LOT BOCK O z4 ZONExaLvUMOF: DWELLING UNITS(4 7UILDI G�� Y-4-, a.,14
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NAME STREETADDRESSCITY ST n I
ZIP PHONE�
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CONTACT PERSON PHONE
CONTRACTOR FIR
M NAME STREET ADDRESS CITYSTZIP PHONE
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CONTACT PERSON
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LENDER FR4A S , CITY STZIP
PHONE
CONTACT PERSON PHONE
IS THIS PROJECT EXEMPT FROM THE STATE ENVIRONMENTAL POLICY ACT?
IF YES,WHAT CATEGORY? IF NO,ATTACH CHECKLIST.
PERMITS REQUESTED: INDICATE IF FAST TRACK [ ] OR EARLY START [ ] (Add.Fees Req'd)
PLAN REVIEW [ ] GRADING [ ] BUILDING [ ] ELECTRICAL [ ] MECHANICAL [ ]
FBH/MH/MOVE [ ] PLUMBING [ ] ELEVATOR [ ] BOILER [ ] DEMOLITION [ ]
NEW BUILDING [ ] ADDITION TO EXISTING BUILDING [ I REPAIR/ALTERATION [ ]
BUILDING USE CAPACITY
PLAN REVIEW
NUMBER OF PARKING SPACES NUMBER OF FLOORS NUMBER OF BEDROOMS NUMBER OF ROOMS
OCCUPANCY GROUP CONSTRUCTION TYPE SQUARE FOOTAGE OCCUPANT LOAD
GRADING: YARDS CUT YARDS FILL SHORELINE? (If yes,fill out additional form)
FACTORY BUILT HOUSING II MANUFACTURED HOME // MOVING
MANUFACTURER MODEL UNIT SERIAL NO. INSIGNIA SERIAL NO.
SQUARE FOOTAGE PLAN APPROVAL NUMBER RELOCATION[ ] DEMOLITION [ ]
PREVIOUS SITE STREET ADDRESS CITY ST MILES FROM SPOKANE CITY LIMITS
ELECTRICAL
For ALTERATION or REPAIR of an existing building,enter NUMBER OF UNITS.
INDICATE NUMBER OF: LIGHT FIXTURES OR OUTLETS SWITCHES RECEPTACLES
INDICATE NUMBER OF HORSEPOWER,KILOWATTS,OR KILOVOLT AMPERES:
MOTORS TRANSFORMERS APPLIANCES HEAT: ELECT BASEBOARD RADIANT ELECT FURNACE
For new or altered SERVICE: VOLTS AMPS PHASE TEMPORARY SERVICE [ ] CONST.WI RING [ ]
For NEW construction or ADDITION,enter SQUARE FOOTAGE by use:
WAREHOUSE AIRCRAFT HANGAR AUTO STORAGE GARAGE RES.ACCESSORY BUILDING OTHER
INDICATE HEAT SOURCE: ELECT BASEBOARD[ I RADIANT [ I ELECT FORCED AIR [ ]
Miscellaneous: (explain)
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pA I- Fee -� 54,00