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1986, 09-15 Permit App: 00013140 Garage (THIS IS NOTA PERMIT) /3 -5-6 BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND COMPLETE IN INK (Please return this original and your building plans to the Department of Building and Safety) SHADED AREAS ARE FOR DEPARTMENTAL USEtsjectNifmber Owner's Name- LAST FIRST MI I�® k) Project Address(Street Name tuber) 4-e5kc4-("-- � Zip Applicant Address City State Zip Phone ( ) Business Phone ( ) Contractor/Agent Address r'�njc � ✓ f� 7/o 6 £. /Z �,(� City State Zip Phone �7- Contact" License Number(Required) Business Phone Spoe A s t 66 GIPS' ( ) qz7- Architect/Engineer Address City State Zip Phone ( ) Contact Business Phone ( ) Lender Address City State Zip Phone t� ( ) Describe Work T*'`` 3©� ) Subdivision/Plat NametShort Plat Number .. M4uM" C-td $Rod Assessor Parcel Number Lot Block Plat Number Pertinent File Numbers Zonal "Comp.Plan Census Tract t3Strr3 Number of Dwelling Units Number of Buildings` Lot Size(Sq.Ft./Acre) Depth Frontage Front Setback Left Setback Right Setback Rear Setback R/W Width Additional Information Square Footage 2 0 4 2 ccO IA. 2 2 0 a CD Number of Bedrooms Building Technician Date Group Type • DEPARTMENTAL REVIEW Cond.Approval Approved Hold 0 Z � Environmental Health Application# i • 111W. 1101 College // ) r Room 200 •1i •- ,. `� 4 Planning/Zoning ❑ N.721 Jefferson - Engineers ❑ N.811 Jefferson Utilities - I ❑ N.811 Jefferson Plan Review/Fire Prevention ❑ N.811 Jefferson Other(SEPA/Critical Material/etc.) 111 ❑ Fast Track/Special Inspection Information Project Representative Phone Address I certify that I have examined this application and state that the information contained in it and submitted by me or my agent to compile said application is true and correct. Signature 17 a: Date POKANE TRUCTURES e//G 2 z--- /9 /9„ . id of , /s>'/'`'G / - 1� moo' • d'=.�— w 2$z' si \�l 1 E. 7406 SPRAGUE, #3 • SPOKANE, WA 99212 • (509) 927-0655