Montgomery E 10925 Village Square Realty - rem & Add & Pole Sign
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BUILDING PERMIT APPLICATION WORKSHEE 4.,
PLEASE PRlld) AND COMPLETE ONLY THOSE PARTS OF THE FORM Y r'~ i~ 1R G i y
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(Please return thls originel and your buliding plens to the Deparfinent of 8ullc ~
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~ CHEMICAI NAME 6ENERIC NAME V QUANTITY IOCATION T4 BE ST,..-~D
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Explanatory Notes
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DEPARTMENT APPROVALS
This is not a Permit
Apptication Type
(Standard unless (Indicaled approvals required in either release or release wlth conditlons
otherw(se indlcated) o space prior to permii issuance
0 Faet Track
o, Early Stert Release
Release ' w/cond 1 MolO 2 ~
ge Emlronmentel Health 9K Commerclal Ll Residentiat
W 1101 Collepe 0 New Constructinn 0 Bldg alterationladdNlon
Room 200 ~ Cl Addltional atructure
APPLICA ~N p
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CondltlonalCommenis
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u Plannlneitoning ~KCommerclal O Cert of Exemptfon ❑ Frantage
N 721 JeNerson 0 Setbacks 0 lot wId 0 lot stze 0 uselzone
C] CU variance zone change shoreline 0 fence,
a Other
Condltione/Comments JE~r-,. W
OL
Englneers L~ Commercial 0 Residential 0 Flood Pialn I#W
N 811 JeMereon 0 dralnage l, new accesslapproach O fence
O road impravements
Condit(one/Comments -
Ut111Ues
N 811 Jefierson
Conditlona/Comments
13 Other
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~ Plan Exam • ~ ~ .
Fire Prev
Condltlons/Comments ,
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ce Agencies Pertorming Speclal inspectlon
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1!nalcete above or attach oondltions relative to final ea bullt approval
Z Ittdicate ebave or eftach reasona for hold
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BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THQSE PARTS OF THE FORM YOD UNDERSTAND
Aft ~
(Please return thla original and yuur building plans to 1hs Depattment of Bu(Iding end Satety)
1 pww eftz lm~ Daportmrn tJrd+ly
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L,, Z ARTMENT USE ONLY s ~t * ~NNW
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8 Dwelll No af Bulldinps 9q Ft 1Aare Oepth FroMage
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9 Lp Gry State Phone
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12 Revtew Requlred PIEn CheCk (YIN) ~Other (YlN) SEPA Exempt (1fJN) Date
15 Type Wak r Bldp ~ MH New ❑ Replaoe OIAe►
FUe ^ pemo 3~ Add/Alter 0 Mor►e
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contw1 peraon Phons If dlHetent than aEove
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DEPARTIVIEPIT APPR01/ALS
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This is not a Permit
Appllcation Type
(Standard unless (IndiCated approvals requfred tn either release+' or rrelesse with conditions"
otherwise indicated) apace prior to permlt Iseuartce )
❑ Fast Track ❑ Early stert Releass
- Ftelease w/cond 1 Hold 2
~ Environnnental Nealth Commercial C1 Restdential
W 1101 College 0 New Construction 81dg alteratlon /edditlon '
Room 204 0 Additfonel structure
APPLICATION q
CondltianslComments
Plannfng/Zoning eCommerclal 0 Csrt of Exemptlon, Q Fronte8e
N 721 Jeftereon D Setbacks Cl tot wJd O lotsize O use/zone
O CU var(ence zone change shoreline 0 fence,
~ D Other -
Gonditians/Comments
1 - -
Englneers [9r Commerclal ❑ ~ Residentiel ❑ plood plaln f/8~85
~D N 811 Jetferson O dreinage C] new eacesalapproach O fence,
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~ ❑ road improvements
CondltionslCommenta
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Uaiiues N 811 JeNerson
CondltlonslComments
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❑ ' Odisr
ET + Plan Exam ~
Flre Prev
Conditlona/Comments
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ABencles Pertorming Speclal Inspectlon
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1 Ind[cate above or etteah aonditlons relatlve to flnsl ea bullt epproval
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1'h16 bullding permit rev[ew is in[endrd to ippraiete you, of the imNruvemelitrs ( ruddway, side-
eralk, cutb, etormvater, rtc. ) vhteli mubt h~ iLonbtructed in eesociatiun witti yuuc buitdir►g
permit. Thie checkliat vill be fllled vtit by tloe Engineec's etaff and a cupy vill be re-
tusned to you at the [ime that the permit is initieled by the Bngineecing Orpactmeat All
requitreamente ebet 1 be completed pciar to tesuenc.e of the building peranlt. A11 unchecked
boxe• ceqvice additionel reeearch or informetioot to make e detetmination.
t• Stotodetec Oraioe e Coneiderations
IL• lec gu a nee oc 'Stormt+atec Management 1981 both an and off eite.
° l. 208 Coneideratione• ~ Yes ~ Nc►
~ 2. Flood hesecd zone coneidecations,11,* a Yes ~ N0
d
~ 3. Stocm Drainege Plan ~ Yes ~ No
~
R II• Plsnniog Action /
~ 1. ResoA•. Cooditional Uee or Veriartce oaiproperty a Yes ~ No
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Z. As• ntquiremeots of planning sction lacocporated ti Yes ti No
Iata aite plaa
III. P&bt o! 6daX
l. Doe• pecait nec*eei tate g• 0 wo dsdicstian a Yes ~ Iao
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2e Qt d soao c.haqg0 raqui ee it. 0. M. ded icat ion ~ Yes ~ Ab
Asdiur at cornor ~ Yes ~ !b
Ioe Couaty jtosd Iapcovamnts
RoBd• aeed to ba lapcoved. Kav wide a Yes ~ No
Ze Curb p Yes ~ No
3. CBPIQID agceemeot (Copq of deed. caAtract. oc p Yes ~Nb
title cmpoct cequired.)
4. llans For iaiproveseats pcovided a Yes ~ No
5. Sidevalk a Yes 1~10
V. PockiAo Plan 6 Aeproacb Location
l. Etevlev and sign off by Treffic 9/"'Yes Ll !do
2. Approach Pe rmlt f com Bng i nee c' • Of f ice ti Yes
~I~lo
3. State or City siKn off ti Yes No
6. Ia this road om 6 Yeac Pta~o Li Yes ~ No
VI. ULID Agreement Li Yes ti No
Vil Field Revtrw Pre! imlndry Wmmeli te fio-
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bit •r ! 1 ti I ~r (%I I 1) ( 11 1 1 il I 1 tHW It ! M 1l1 1) 111! liI 1981. Nil 1{+ oil (itt I1 ( off 1s'
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~ #4 SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY _
NORTH 611 JEFFERSON I SPOKANE, WASHINGTON 99280 I(509) 458-3BT5
APP!lCANT COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREEf AODRES9 PARCEL
1 09 T01-~
10905 EAST MONTOOMERY
2 LoT etoc+c suenwIsiora LEGAL DESCAIPTION
OWNEA PNONE PHONE
~ VILU4GE SQJARE REALTY
v MAILING AOORES9 ZIP Actuo) Set Soft MFeell m'
10807 EAST MONTGOMERY 9920 Nwth lg~ Ead Want
COMTRACTOA LIGENSEEXpIRE9 PMONE SIm dPefoel -
reCtoesiticeNon ROefdentlal D
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DYIIN SIONS b DZSPLAYS ~~a ~~'-9191
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AOORESS DP lype0orot OauPexY Sp►Inklered
TREET 99207 t]Ya ONo 3Aeq d
OEStONER PMONE NewG1ai11 Vslustlon RemodMeO Valuailon Totei Bldp Piow Aree
4ppp.00 120 SO.FT. SIGN
5
a00AESS DP Mdn Roor uppr Ftoon Garepelswpe aroenho~e
GMANaE OF USE fROM TO Ower DxM lhC► Oeck Fln Bwement UMin Bmement
6
No. eab No Ftoora No Fln Raomi No owelunge
TYPE N NEyy 0 ALT 0 AD'N D RPL Ci MVE
7 OF C~OTHER
w BLO ~ PLMB ❑ MECH 2 M H ❑ POOL Owtlft d6oempt Rsqu*ed Yeell NoO NUagM
WORK aywww Reoskoee Yeeo Hon
OE9CAI8E WdAK 8horoilnelfFbod Ftazord plmie Requlnd 0
8 INSTALI. POLE & O/F6X20 StON rasQ Na ~[3 Fleo~vea c
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iaLuATIo" souRCE cas ELEcTaic ~R ~a a""'nl'ip FEEB COLLECTED
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UT~LITIE8 PRIVATE 0 SEWER 0 I hereby certify that I have read and examined thie applicatlon and have read the "NTICE' Included on
O provlelone
reverse alde and know the eame to be true and correct Ali provieions of lawa and ordinencss governing thb type of
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orlc wlll be cam0Ifed with whether ePeCIfled here(n or not Tlte Arentin9 of e Aermlt does not Presume to 9ive eu
Ihority to vloiate or cancel the provieione of any other atate ar local law reputetinp constNCtlon or the performence
al construction SEE R RSE 81 FOR REOUIRED 1N8PECTIONS Ptuntdnp
Sl(3NATURE OF APPLICATION
1?•21•83
AWNER OR AGENT OATE Mecn
8PECIAL APPROVALS 8PECIAI ODNOITIONS (SEE AEVERSE SIOE FOR NOTICE) 35.00
PiIEIIM FINAL DATE ~ ~
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SEPA
Plertmrtg
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Erqurm ir ~ OtAer Mectfy) 54• 00
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ututtim ~
89.00
SEPA TOTAL s WNEN MACFIINE VALIOATED IN TMIB 8PACE
aiorr PERMITl8 NONTRANSFEflABLE THM gECOMEg A PERMIT
E°'" WORK HA3 NOT COMMENCED
PERMIT 19 NUII ANDV010 IF
IN 180 OAY9
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OAIEUMM PERMITNO 10TAt
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