1985, 05-24 Permit App: 00005105 Residence •
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 A CAD
(last) (first) (m) Department Only
S. illi r CD14,S �-. � I Res. Comm
2 Project Address(not Mailing Address)or Road Name Space Zip
E . tD.8z- c9"
3 City/Community
�`''/'�` State tt Subdivision/Plat Name A n ►—
4 Ass5rpo No. KR_ Lot W' B 14 1 I ' cast- Anz. a 1 X18,..
Q 7 J 1 2_ — 3 0 I i i t 4 * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone �� Project No. ' ' r os-
6 Dwell 4 No.of Buildings Sq.Ft./Acre Depth Frontage
r f goo
7 Set Bx�Back-Front 5 �(L)�� (R)S-2� �R�� Census Tract Module No. Initia���
* 16 Architect Firm Name Street Addresss _
.1) 4-t`‘—‘ t Ods , ., N ,0405- Div ►s i e-,.,
Zip atly State Phone
CM 7.0 g 5po t€0.444, W At. ( Sot l 8 3- 74.00
Contact Person�'� C Phone if different than above
Jl `u`TT^ h, S V iZ\V%-.4\ ( )
Contractor Firm Name Street Address
St i� . Co s -- I3 ( F E . a7
Zip City State `CQ� ) � ^ 2-'1 (y
gR2i tt 1 uM . Phone
J 2.2.
,'
Contact Person License No. Phone if different than above
I1JAM•YZatok WA-114'6.K— CCo( SWCt)h 13a.v ( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(Y/N) SEPA Exempt(YIN) Date
15 Type Work 11 Bldg ❑ MH JK New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work f
1000 QQ.a.c. ,t'J _ w/cI4 4a€
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
rel F = (551
/ e
De. = 12� I ,
1') .5-7121 ,? j;.
� ' •
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
w/cond 1 Hold 2
- ;
Environmental Health ❑ Commercial; CI Residential
W.1101 College New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
APPLICATION# ,151-e:3,13
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:
}3 r
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; --
N.811 Jefferson
—N.811Jefferson ❑ drainage new access/approach; ❑ fence;
❑ road improvements FAM1
Conditions/Comments: F/V/�
Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
•
Plan Exam
Fire Prey.
Conditions/Comments:
a
c❑
Project Representative Telephone
o. Agencies Performing Special Inspection:
Y O 1.
O --
E 2.
y o
LL
• c
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
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LEGAL DISCRIPTION /7� .
Lot 11 , Block 4, Hillcrest Acres Second Addition, In
according to plat recorded in Volume 7 of Plats , q
• page 41 , in Spokane County , WA, excepting therefrom
a portion described as follows: , y
Beginning at a. point on the east lin _ -
of said Lot 1 1 , which is 38 feet Northof the
PRRCEL +�` 27542-301/
Southeast corner thereof; thence Northerly
along said East line, a distance of 92.59 DRAWN BY W Pi.WALKER
feet to the Northeast corner thereof; thence 4-18-85
Northwesterly along the Northerly line of said
Lot 11 , a distance of 11 feet; thence Southeasterly, J
a distance of 96 feet to the point of beginning. SO4Le/ � T