1986, 02-03 Permit App: 00009609 Shop BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) �� // / (first) (m) Department Use ly
�i a.- Q�-4.-Q-yi/) Fps. Comm
2 Project Address(not Mailing •r • Road Name / Space Zip
Z-R,%_ ..-- N-
3 City/Communi State Subdivision/Plat Name
`-� 61---/-- - GCS Of.--- Njt 0 N UV 4.14
4 Assessor Pa" I No. Lot Block
2-7 7 9 4.4 — '2- Z ' a/ / i * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# Zone
Project No.
d
6 Dwell# No.of Buildings Sq.Ft./Acre Depth I Frontage
7 Set Back-Front .
-1 i (R)S-2 II Rear Census Tract Module No.
7,Y 1 .11 MG S - 4 6> t ,jtu,s (t\ -
16 Architect Firm Name Street Address *
Zip City State Phone
( )
Contact Person +
Phone if different than above
( )
Contractor Firm Name BRANSON UNITED STEEL BLDGS, Street Address
1'7,24 SPl;4f UE
Zip srdlb, WASH. 99206 State Phone
I I ( )
tact4.62_,fre__47 License N�oo.1) S^ i-
Phone if different than
�a7bove /
8 Ow r/Agent(if different than#1 above) Business Address
9 Zip City State Phone
12 Review Required Plan Check(Y/N) Other(Y/N) r SEPA Exempt(YIN) Date
15 Txpe W 7,k ❑ Bldg ❑ MH .--.E New 1 ❑ Replace ❑ Other
Fire ❑ Demo ❑ Add/Alter ❑ Move
14� ElDescribe ork G.2-6 X
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
DEPARTMENT APPROVALS
This is not a Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.) r --
Fast Track
Early Start Release
Release
• w/cond 1 Hold 2
0 , Environmental Health ❑ Commercial; ❑ Residential 1
W.1101 College ❑ New Construction; 01 Bldg alteration/addition lea-ht,/
Room 200 EI Additional
structtuure;
APPLICATION# v '" /' ` •
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:
74, Project Representative Telephone
a Agencies Performing Special Inspection:
ci) c
O 1'
U —co
�`— E 2
7, o
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LL
3.
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
MAP SHOWING L( iTION OF IMPROVEMENTS ON 6 OUNDARIES OF a
Let 71 in ''. -10,-- 12 njnt-i.l '.r 1_ 4th Add. , ''277cent th-,t nortien
conveyed to S;noknTno Count- for ro-d purno.3es by Deed 462661c,
AND EXCPT the South 5 feet thereof
AS PER PLAT RECORDED IN AUDITOR'S OFFICE, COUNTY OF SPO-
KANE, STATE OF WASHINGTON.
I HEREBY CERTIFY THAT I HAVE SURVEYED THE ABOVE DESCRIBED
PROPERTY AND THAT I FIND THE IMPROVEMENTS SITUATED AS SHOWN
HEREON AND THAT THEY DO NOT OVERLAP OR ENCROACH ON PROPERTY
LYING ADJACENT. NO IMPROVEMENTS ENCROA ON THES REMISES.
V. 1 1 . CAMERON
OWNER: 'olf?_^nf3. Inc. PROFESSIONAL LAND SURVEYOR
". 13F315-32n0
SURVEYED: June 15, 1970
LOAN: .
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