BROADWAY E 5217 Safety & Supply Co. - Sign
/n ~ Z BUILDING PERMIT APPLICATION WORKSHEET
/ PLEASE PRINT ANO COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Please return this original and your buitding plans to the Department of Building and Safety)
t Owner's Name (last) (hrst) (m) Oepartment Uae Only
Safety & Supply CO. Fbs• IComm
2 Project AUdress (not Mailing Address) or Road Name Space Zip
E. 5217 Broadway, Spokane, WA. 99206
3 City/Communily State Subdlvlsion/Plat Name
Spokane WA•
4 As.gesaor Percel No. Lot Block
DEPARTMENT USE ONLY w w •
~
5 Sic Code Zone Act. M Zone Project N~
h~~,~r ~ ~41
6 Uxell M No. oi Buildines Sq. FtJAcre Depth ,orontage
8 t /
~ 7 Set Back-Front (L)S-1 (R)S-2 Rear C'ensus t Module No. Initials
.t. !~~"+-v, ,
~ 76 Architect Firm Name Street Address *
Heath Northwest, Inc. E. 411 Spr que
Zip City State Phone
992fJ2 Suokane WA (509/455-8666
Contact Person Phone if dff rent than above
Chuck Nelson ~
Contractor Firm Name R Street Ad
Same dr
~
Zip Gty State ` P ne
\ ~ ( 1
Contact persDn Llcen No. Phone If difierent than above
/ Hea~h N 3 30~tJ
8 OwnerlAgent (if di(ferent than Nt abo ~usiness Address
9 Zip City State Phone
/ ( )
12 Review Required Plan Check (Y/N) Oth& (Y/N) SEPA Exempt (Y!N) Date
. ~
. 15 Type Work O Bldg 0 MH 0 New O Replace Other
O Fire / p pemo CJ Add/ ter ❑ Move
14 Describe Wark
Siqn Installati n - ~luation 7.000.00
10 Applicant Name Street Address
11 Zip City Si te Phone
` 1 )
Lender Street Address
~
Zip City ` State Phone
J c ►
Contact Person Phone if dlfferent than above
( )
Additional Informalion
141
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DEPARTMENT APPROVALS
.
- This is not a Permit
Application Type
(Standard unless (Indicated approvals required in either "release^ or "release with conditions"
otherw(se indicated) space prior to permit issuance.)
FastTrack ~
~ Early Start Release
Release w/cond 1 Hold 2
0 Env(ronmental Health fl Commercial; p Resldential
W. 1101 College U New Construction; 0 Bldg alterationladdltion
Roorn 200 Q Additional structure;
APPLICATION #
Condltions/Comments:
~ Planning/Zoning: O Commerclal; O Cert. of Exemption; O Frontage;
N. 721 Jefferson O Setbacks; O lot w/d, • ❑ lot size; O usel2one;
.
❑ CU, variance, zone change; shoreline; ❑ fence; L
❑ Other .
Conditions/Comments: • =~L-'.•~- ~y~- ' .~,j:L_ ~
~ • ~ ^'~~a~
Engineers: 0 Commercial; D Residential; ❑ Flood Plain,
N. 811 Jefferson ❑ drainage 0 new accesslapproach; D fence;
❑ road improvements
Conditions/Comments: to4CG~ed 5! *t" /rJ~~/1/•
~ Utlltties:
N. 811 Jefferson
ConditlonslComments:
~ Other:
❑ Plan Exam
Fire Prev.
ConditfonslComments:
a •
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Project Representative Telephone
V
~a Agencies Performing Special Inspection:
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R1 ~p
H- E
2.
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3.
1 Indlcate above or attach conditlons relative to final aa bullt approvai
2 indicete above or attach reesons for hold
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