1985, 03-18 Permit App: 00004521 Storage I
• 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 Name (last) (first) (m)! Department Use Only
Ac- / aT/�� l"i k.. lin. y Comm
2 Project Address(not Mailing Address)or Road Name Space Zip
I 020 S. a.2.3
3 City/Communit Stet, Subdivision/Plat Name
City/Cr
1 'CLAt iY! 9x1\1- SDP( Tic)
4 Assessor Parcel No. Lot Block
,X is/S- -33
3 _ 0 p3 c Zio z i 7 * . * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone Project No. I�
-312f� 52
6 Dwell# No.of Buildings Sq.Ft./Acre Depth i Frontage
k 2 I3 &- 156 t
7 Set Back-Front (L)S-1 (R)S-2 i Rear I Census Tract Module No. Initials
-�tr��� p • Z> iU ( .
* 16 Architect Firm Name I Street Address ,I
Zip City State Phone
( ) I
Contact Person Phone If different than above
( )
CoC-rector Firm Name Street Address
G t? ,124/1,C.) e r 672E k%luc ;: J' Jr
Zip City State/� Phone
3 IC --7( Fr&—. I / (.;sof ) 773- c2.1-60.3
"tftet Person License No. Phone If different than above
cF�4i (io k-S1 ilk L5�1/ :7 ( )
8 Ownerl Sit(if different than#1 above) ;/t 6 Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(Y/N) SEPA Exempt(Y/N) Date
15 Type Work O Bldg ❑ MH ❑ New ❑ Replace ❑ Other
❑ Fire ❑ Demo g Add/Alter ❑ Move
14 Describe Work
A°(TAtic
G (1D!'4 - al0 ev1k n1 F 576,,C
10 Applicant Name Street Address
4
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
W.1101 College ❑ New Construction; C Bldg alteration/addition
Room 200 ❑ Additional structure; 5—?/V-?3'
5
APPLICATION#
Conditions/Comments:
Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
❑ Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
. N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
❑ Plan Exam
Fire Prey.
Conditions/Comments:
a
N
-t▪ 1] Project Representative Telephone
cn Agencies Performing Special Inspection:
c 1.
. O
U '—
co 7,3
~ E 2.
y O
O
LL
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
feek sTibk-Ect
BuILDI NGs
Post Falls,Idaho (208)773-5809
Spokane,WA (509)455-5139
Name
Address
City State
County Zip
Telephone
Representative
Lois— ' /3 — Zz �5 `�
3? ,4
-47
Z 6/A `02- ZO � Z. 8/IE it
4c-r 77
071-,.'..s.-753 -o?3 " x
1
/3S
4.7%."--4?
5