1986, 05-01 Permit App: 00010795 Garage (THIS IS NOTA 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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
Project Number 7�
Owner'sN LAST FIRST MI ! J
5)
Project Address(Street Name&Number) n 4 Zip
Applicant ,� Address
:ii,___ ,... ,:, / �r �! State /� / Zip �J phone (�9 ) Z ���
2- as�tt F9' / 4 q /
Business Phone
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Contractor/Agent Address :7
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�� S'Tr� � 7ut�� : 7 'aG �; i �
City State Zip Phone
.....„4
Contac License Number(Required) Business Phone
�211/t�S ( 1
Architect/Engineer Address
�6tir �S' �, �ir��s Cie F
City State lip Phone
", 54
Contact �D� ��� / ( )
d Business Phone
`r c S
Lender Address W
Qs� Sa��
City State Zip Phone
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t , Res. Comm.
V
'abort'
atIuynber-
C' utei Number Lot Block Plat Number
�`? 4b�-( 4-
comp.Zone Comp.Plan Census Tract
- d?t� t
a nQ i at ;c _Number of Bu - Lot Size(Sq.Ft./Acre) Depth Frontage
°x �
2
Left Setback _ Right Setba Rear Setback R/W Width
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oota e
Square--
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. � a
of Bedrooms
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r� Date Group Ty
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DEPARTMENTAL REVIEW
Approved Hold
Approval
Environmental Health Application# —ff--IL ` / .i %
liW. 1101 College
Room 200 / J
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'41.ID )4 4 Vi/liT /ti rit,; *� , —
a
Planning/Zoning
❑ N.721 Jefferson
Engineers
❑ N.811 Jefferson
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention
❑ N.811 Jefferson
Other(SEPA!Criticai Material/etc.)
0
❑ 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.
Signature Date
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E. 7406 SPRAGUE, #3 • SPOKANE, WA 99212 • (5O9).92 -O655! .
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