Pines N 324 Mirghanbari A. Signage
BUILDING PERMIT APPLICATION UVORKSHEET
PLEASE PRINT ANO COMPLETE ONLY THOSE PARTS 4F THE FORM YOD UNDERSTAND
(Piease return thia original and your butlding plans to the Oepartment of Bulldingtand Safety )
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OEPARTMENT USE ONLY ♦ f a
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DP cily Phone
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Street Addteas *
Zip City, Stete Phone
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~ DEPARTMENT APPROVALS
This is not a Permit
Appficatlon Type
(Standard unless (Indlcated approvals requlred In elther °retease' or "release wlth conditions'
otherwise Indicated) gpus prtor to permit isauance
❑ Fast Track
Early Stert Release ~
Release w/cond 1~ Hold 2
❑
Emrironmental Heaith L] Commercfel, + 1 Residentiel
W 1101 CoUepe L1 New Conatruction, r Bldg alteration/addlNon
Room 200 0 Addltlonal atructure,
APPLICATION M
Condltlona/Comments
~ Piannlng/Zoninp 0 Cflmmercial, O Cert ot Exemptton, 0 Frontage. N 721 Jetferson 0 Setbacks, 0 lot wld, 0 lot slze, O ude/zone,
0 CU, variance, zone change. ahoreline, O fence,
O Other
Conditlona/Commenis As
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~ EnpinNn: W Commercial, D Resldentlal, O Fiood Plaln, ~ l t Qf ~ S
N 811 JeNereon ❑ dralnape CI new acceselapproach, 0 fence, ~
C] road i pravementa
Condltlons/Comments K e- s
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N.811 Jelferson
(bndlttonelComments
0 OtMr:
Plan Exam
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Condltlons/Commenta
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Pnolect Repreaentatfve Telephone
~ AQenctes PerforminQ Speclal Inspection
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1 indkats,bove or sttecA conditlons relaihrs to Ilnal as bulit approvel
2 indlests abave or sttsch reaeons tor hold
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PLANNUMeER ArrLiVq i njn/ riLnmi i
' " . SPOKANE COUNTY - DEPARTMENT OF BUILDINO & SAFETY NORTH 811 JEFFERSON 18POKANE. WABMINGTON 9M 1(60l14S6-816
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HAAD TO MAKE 3 COPIES
;TREETApDRIEgg PARCEL NO
~ ,9r-n, 2.11-ez ~.d.-I,? 15543-2824 ~
LoT susawaIon EOALOESCRIPTION, The 'Test 186.9 feet of the
2 o .ioYth •ialf 124 of OPP~'T'. 1IiI' as ~ i
owN~ PHONE PHONE .r1c+~ r i',
11000{ ~
'r! `2 2 N - l per plat t►iereof xecorded iho "olume .
3• , A • v ' r s
Maiuao aooaESs ZIP
Hord, Isann JrNt ~ west
CONTAACTOR + LICEN9EEXPIAES ftCNE SimoiParoel zat6Claeelfieelion pgs~~ O
• . ~ = ~ ~ u - ~ ~ ~ Qanr~endel
4 AQDRESS o ~ ZIP TYPOC" Oacupancy 01ied ~0 ~
QESIGNER CReq'd
PHONE Now Owet Velttelwn RemWeled Valualion TOtel BIOg Ftoor A►Ea
5 d +
aDDRESS Z1P Moln Floo► Uppe► Flaars GargelSioraOe Greenhouae ~
- 'a- 1 ~N`~ ,
CMAN(iE OF USE FROM TO Omer oock uno+► oeas fln Beawrient umin ea3ement
6 No eattm No ~oo's Ne pn aoome No owelur~s
TYPE ~ NEW ~ ALT ^ AD' N ~ APl C MVE ~ OTHER
~ OF BLp ~ pLMg 0 MECH L M M 0 POOL Ce~tm atExempt Requlrod YeeO NoC numeer
WORK a varianoe peodred YeeO Nor
,
QESCRIBE WORK 9ioreilnedlRood Hamrd PI~M FieOulletl 0
g veeD Not apoiio 0 Reoe+vaa o
'eaWAtION SUURCE GAS EIECTRIC WATER sEwaoE Ownerobip FEES COLLECT6D
OF PUBLIC ~1 8EP'TiC
9 UTiIITIES PRIVA?E ~ SEWEEEi ~ ~ ~le
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I hereby certify that I have read and examined this eppllcatlon anG have read the "NOTICE" provlslona included on
revene side, and know the same to be true and correct All provis(ons of laws and ordlnences governing thia type of Buiiding
work will be complied with whetner specified herein ar not The granting of a permlt doee not presume to give eu-
thority to violate or cancel the provi%lons of any other tat r I regulating constructlon or the perbrmertce
of constructlon 8EE REVERS S /FO REO Plumbinq
SIGNATURE OF APPLICATION,,P,,,, ~
OWNER OR AGENT Da~
SPECIAI APPROVALS SPECIAL CO ITIONS: (SEE REVERSE SIDE FOA NOTICE)
PREIIM FINAL DATE
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WHEN MACMINE VALIOATED IN TMIS SPACE,
PERMIT IS NONTRAN9FEpABLE THI8 BECOMES A PERMIT,
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCEO
e,ii~ino IN 180 DAY8
'eM oAte IssuEO PERMR No t(T9 aL
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