1984, 06-12 Permit App: 00000634 Residence BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(iatease return this original and your building plans to the Department of Building and Safety)
1 Owner's Nems (last) (first) (m) I Department Use Only
Me(1r P 1-11 "7,;-(,,-! i Rss. ✓/ Comm
2 Project Address(norMailing Address)or Road Name 'E, k'/Z0 3 e-n-V Zip
yo i 1 11r v I r7i 1 nma 1 qt Arlr1i i i n '99206
3 City/Community I
State Subdivision/Plat Name
j„Gi> ,,e Wn . Nidi mmR 1St ild ition
4 Assessor Parcel No. Lot Block
3. 4-1 -14 O t * * * DEPARTMENT USE ONLY * * *
_
5 Sic Code Zone Act.ti Zone Project No.
6 Dwell N No.of Buildings Sq.Ft./Acre Depth Frontage
X33' Cc3.5.7S
7 Set RackfFront (L)S-1 (R)S-2 1Rear
Census Tract Module No. I • ala
* 16 Architect Firm Name Street Address
own plans 3_ AF,21. Van Marter
Zip City Spokane stat'Wa. Phone
9206 a.
92R-10q7(1A7
�ontact Person n Phone1fdiffeerent than above
ichael D. McGrath ( )
c«,tragt ichae1 D. McGrath Construction street{4ddrees
TiA 211 Van Marter
9p9206 CitySpokane state V ra• Phone
(�
97
son Li rn nse Phonelf different than above I 26_ r) '
Tc iael D. McGrath. .AMD2520C 223-01 ( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(YIN) Other(YIN) SEPA Exempt(YIN) Date
ACs *
15 Type Work Bldg 0 MH New 0 Replace 0 Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe Work
Coratr-ct single family residence
10 Applicant Name 1'1cGrath strut.dcrio214. Van Tarter
1,Achael D. 1
11 Zip City State Phone
9` 206 Spokane Wa (509 ) 926-1097
* under Washington Mutual Savings Bank StreetAdd►e 1 Main
Zip City State , Phone
99201 Spokane Ia. ( 509) 455-7771
Contact Person Phone if different than above
Joe : .hr ' ( )
Additional Information
141470 `-) /VW k 3
q-,?_,o di 6 4-e
( 6 0 (-44P
r
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 i
❑ Early Start Release
Release w/cond 1 Hold 2
-IP(
Environmental Health CICommercial; CIResidential
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
APPLICATION#
Conditions/Comments:
0 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:
� Z2�E1,t‘dential;
ngineers: CICommercial; ❑ Flood Plain; I _ , QN.811 Jefferson CIdrainage ew access/approach; CI fence; �'€€le5r
❑ road improvements
Conditions/Comments:
LI Utilities:
N.811 Jefferson
Conditions/Comments:
D Other:
LI Plan Exam 67/ (FY
Fire Prey. / r.
Conditions/Comments:
a
a
c
ro❑ Project Representative Telephone
U
a Agencies Performing Special Inspection:
cn
Y O
c 1,
UO '
H E 2.
y 0
ms u_
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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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