1986, 03-17 Permit App: 00010069 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)
JriHUCU Hri CHJ /AMC run UCrMr1 I IVI CIV I HL LJJC
n
Project Number i��/ 1/
CC.��� CCJ�
Owner's Name LAST FIRST MI
Na zsc. "if e I 4..___0
Project Address (Street Name & Number) Zip
it) 3 O -7 LI &el 1 CI ` S ,k z - 19.Z o G
Applicant
Address
City
State
Zip
Phone
Business Phone
( )5%?) /6 3"-Y
Contractor/Agent
s
Address
City
State
Zip
Phone
(
Contact
License Number (Required)
Business Phone
( )
Architect/Engineer
!F-rL
Address
City
State
Zip
1
Phone
( _. I
Contact
Business Phone
( )
Lender
Address
City
State I
It
Zip
Phone
Describe Work
1\74 Q 6 A 140,4)
Res.
V
Comm.
Subdivision/Plat Na�mge/Short Plat Number
Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers ,
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
It
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Front Setback
Setback j
Left Setback
RightSetbagk
Rear Setback
R/W Width
Additional Information
IBUILDING INFORMATION
Square Footage 1
.'--e::'
5,4-.,c,
Ste•.
Number of Bedrooms
Building Technician
Date
Group
Type yam'
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 application is true and correct.
Signatur
Date 1 7
/
Approved nd.
Approval
Approval
I:ice"W.
�I
Hold
,
Environmental Health Application #
1101 College/�Room 200kJ
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
exts r c CI —VI2t0
Utilities
N. 811 Jefferson
Plan Review/ Fire PreventionS
N. 811 Jefferson
o
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 application is true and correct.
Signatur
Date 1 7
E; 11812 VALLEY WY
SPOKANE wA ' 99206 \ -
1 I i
, _.. . - Q..vNk-R 1T0 J HAAS
i I LEGAL DEkRIPTION OPPIURTUNI1 Y PTN OF BLK 1127
DAF ; Ni ra. 6' FUT' 3-443.51-Cif -k-75-' or E95'--E. Ek/2-13-F &LK 127
w98' E. EXC E95' .L EXC S340,' E. EX C N170'
' 0 I
• - i •