Sprague E 9919 Spokane Valley Travel
(THiS IS NOT A PERMIT)
f vy BUILDlNG PERMIT APPLICATION WORKSHEET
PLEASE PR1NT AND COMPLETE ONI.Y THOSE PARTS OF THE FORM YOD UNDERSTAND
CQMPLETE IN 1NK
(Pleese return thig orlginel and your buildrnp plans to the Departrr+ent ot Building and S$fety)
SHAOED AREAS ARE FOR DEPARTMENTAL USE
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DEPARTMENTAL REVIEW
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Approved Cond Hold
Approvai
Environmentei Health Appllcatlon #
❑ W 1101 Col lege
Room 240
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Plenning/Zonlne ~,~~N aJ~~r aSe~~
t~1 N 721 Jefferaon
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~ ~Engineera ,AjZw A1~~ ;,e A~i
N 811 Jefferson l~
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utm~ies
❑ N 811 Jeffe`rson
rPlan Revlew/ Fire Preventlon
N 811, Jefferson _
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OMer (SEPA/CrNkal Meterlel/etc:) ~
Faet TraNclSpeolsl inspectlon inlormetlon
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ProJect Aepresentative Phone
Address
1 certity that I have examined this appllcatlon and state tAat the tnformation cantained in, ft and submitted
by me or my agent to compile satd appllcation Is true and correct
Signature Date