1984, 10-18 Permit App: 00002893 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 Name4,./ (last) /� j (first) t (m) Department Use Only
/ E - %S. Comm
2 Protect Address(not Mailingre�yss)or"Road`Na�net���-' 1 ;'1 Space Z���
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3 City/7J.mmunity State Su isionl lot Name
0:— , y-4 Z 0 0
4 Assrcel No. t Block
/1 �<1_ 0 L // I /) 9 * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone Project No. ...Lel 3
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
7 Set Back-Front ) ^0 1(L)S 1 + (R)S-2 9 I Rear Census Tract I Module No. Initials
t,
* 16 Architect Firm Name I Street Address *
Zip City -State Phone
( )
Contact Person Phone If different than above
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...4 tor Firm Name '' �"" _' Street Address
A _ —J ,1 f /�S'oe .KA P
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V City / Stat Phone
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10,x' tact Person
rLise No. Phone if different than above
f PILL A sit°, . oz /y,.,-' ( )
8 O Agent(if different than#1 above) Business Address
' g Zip City State _Phone
( )
12 Review Required Plan Check(YIN) Other(YIN) I SEPA Exempt(YIN) Date
15 Type Work ,\Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Wok,
/4; X 17I c') Ki--fie A, a-1--- / -72 —14---e
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
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 ❑ Commercial; ❑ Residential
'1 4.11
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition VO
Room 200 ❑ Additional structure; , +`=
APPLICATION#
Conditions/Comments:
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; 0 use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
0 Other
Conditions/Comments:
❑ Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; I
N.811 Jefferson 0 drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
Other: I I I I
❑ Plan Exam
Fire Prey.
Conditions/Comments:
a
c
14 Project Representative
Telephone
n Agencies Performing Special Inspection:
co
Y o 1.
U —
f0 ld
H E 2
T o
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LL
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
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!S1 !TEEL ! GS" D" NICS, ..
E. 10919 BROADWAY • SPOKANE,WA 99206 1 (am)928-2276
HOMEOWNER: L l/4 L �` JOSS100"1
:Ut,ES:
1 Bldg. must be 5' from property line ADDRESS: 4f 024/A s4;;Otele,,
2 Bldg. must be 10' from drain field
,3 Bldg. must be 25' from property line PARCEL
if property line is next to a street LEGAL:
:4) Bldg. must be 10' from all existing bldgs.
NORTH (Road) „ .
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SOUTH Road d.erigI x/,
110
1. Draw in all existing buildings.
2. Draw in new bldg. & how many feet it is from existing bldgs. and property lines.
3. Name all roads next to property.
4. Draw in drain field and whether you are on a septic tank or sewage system.
5. 1;14e of property.