1984, 09-26 Permit App: 00002529 Residence r 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) I Department .. a Only
HIMALAYA HOMES, INC. Fa. Comm
Comm
2 Project Address(not Mailing Address)or Road Name Space Zip
10511 E. 14th
3 City/Community State Subdivision/Plat Name
Spokane WA UNIVERSITY PLACE r
4 Assessor Parcel No. Lot 1 Block
01 D,S y G/ 02., 1 3- 9 21 * * * DEPARTMENT USE ONLY
5 Sic Code Zone Act.# Zone Project No.
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
C ` Imo) sz t
7 Set Back-Front (L)S-1 (R)S-2 ( !Rear Census Tract I Module No. Initials
LS s (GJ( i J uN ►�, .
* *
16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
same as above
Zip City I State Phone
( )
Contact Person License No. Phoneif different than above
0(III/YU l 1 G pe. ( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(YIN) ISEPA Exempt(YIN) Date
yes rs
15 Type Work 7ON Bldg ❑ MH Dx New ❑ Replace 0 Other
Residence ❑ Fire 0 Demo ❑ Add/Alter 0 Move
14 Describe Work
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 ���
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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
2 Environmental Health ❑ Commercial; ❑ Residential Th
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure; ' iii .ifV/A;
_ oi.
APPLICATION# Te/----03 9 6 c/ 0 6.41,/
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:
Si 4
61 i
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;,g1tA
N.811 Jefferson ❑ drainage ❑ new access/approach; 0 fence; V I
❑ road improve ents ,
Conditions/Comments: Z__.,.....�_ _ , ,tet..lt -)-CL L-f- &Al, (t
;N11 - D ^ .,,, .- WJ,_, E , ��1 i
❑ Utilities: I
N.811 Jefferson
Conditions/Comments:
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Other:
❑ Plan Exam
Fire Prey.
Conditions/Comments:
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—] Project Representative
Telephone
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a Agencies Performing Special Inspection:
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1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
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1 CONTRACTOR:
t . q HIMALAYA HOMES, INC.
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t (� 10515 E. 14th
LEGAL DESCRIPTION:
O r\ L9, B21, UNIVERSITY PLACE
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