1984, 07-25 Permit App: 00001373 Reroof 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
Sibi erud Lonnie Fes. Comm
2 Project Address(not Mailing Address)cr Road Name Space Zip
L. 11306 10th Spokane, Washin., ton 99206
3 City/Community State Subdivision/Plat Name
Spokane County ti1ashi n •ton Ko,-i0ro r"".°13-'./e"
4 Assessor Parcel No. Lot Block
2 8 t'.2,t' - Z / 0 C. /1 4- /z 5- * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone Project No. 13.73
I
6 Dwell* No.of Buildings Sq.Ft./Acre Depth Frontage
7 Set Back-Front l(L)S-1 (R)S-2 !Rear
Census Tract I Module No. Initials
* 16 Architect Firm Name *
Street Address
wee Above
Zip City State Phone
309) 28-0331
Contact Person Phone if different than above
( I
Contractor Firm Name Street Address
"jce 'ibove
Zip City State Phone
( )
Contact Person License No. Phone if different than above
( )
8 Owner/Agent(if different than#1 above) Business Address
8Pe A ove
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(YIN) SEPA Exempt(YIN) Date
15 Type Work ❑ Bldg ❑ MH ❑ New 14 Replace E Other
OO„ ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work
lipmnirPr9 Ct rlar Shalrp jinnf arirl knplarmr Li c..+. 0ctnh r 19P�
10 Applicant Name Street Address
Znnni e E_ S i 1nl arni L . 113O( 1 nt'n
11 Zip City State Phone
99206 Spokane fiashin; ton ( 509 ) 928-0831
Lender NoneStreet Address *
Zip City State Phone
( )
Contact Person Phone if different than above
See 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 f
❑ Early Start Release
Release w/cond 1 Hold 2
❑ Environmental Health ❑ Commercial; ❑ Residential
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
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:
c❑
Project Representative
Telephone
ca) Agencies Performing Special Inspection:
O c 1.
E 2
1 O
lD
V_ c
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold