1985, 10-30 Permit App: 00008422 ResidenceBUILDING 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 Nape (trill (first) (on)
OePeriment Uaa/ony
Roth Gary W.
lay. kCrum
2 Project Address /rot Mailing Address) v Road Name Space Zip
E. /otio' 4(..i -L.
3 CIty/Community
Spokane
State
�'a.
Sur:ivision/Plat Name
Pond ru Ants Ft,i-1 Add:4...¢�
4 Assessor lNa.
39
W Bio
[.a
* * ♦ DEPARTMENT USE ONLY
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eAA[LN
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5 SicliUe
Zone
Zone
Ati. u
,
Project
Project No. �' I��
Y
8 Dwe11N
No. of Bull Ings
Sq. F1.l A[re !Depth
20#
e
Front 91
I Set Ba -Front IIL)B-1
01/S-2CensusP (Rear
Census Tract
MMule Na.
Initials
• 16 Architect Arm Nene
Design Alliance
Street A dress
N. 1014 Pines
ZIP
99206
Cly
Spokane
State
Wa.
Ph ne
(_509 ) 928-2948
Contact Pew
Don Henrichs
Pion N anierent than above
( )
Contractor Finn Name
Roth Homes
Street
Address
S. 326 Pines
zip
99206
ay Spokane
'State Wa.
mons 509 t 928-2948
Contact Person
Gary W. Roth
License No.
ROTH 1 *203QD
Phone It different than stove
( )
8 Owner/ Agent (n diaeent than Nl above)
Busi
ma Address
0 Zip
City
Slate
Phone
( 1
12 Review Required
Pla Check (V/Nd
Olh r MN)
� ISE A Exempt
(Y/10
Cate
15 Type Work VBldg
0 Fire
0 MH
0 Demo
•Q' New
3 Add/Aller
0 Replace
0 Move
❑ Other
la Describe Work
P&G/DEuCe ujGAteAcre 4(
10 Applicant Nene
Street
Address
11 Zip
City
State
Phone
Lender
Streel Address •
Zip
ay
Slate
Phone
( 1
Contact Person
Phone N dluerem man above
I )
Additional nformation
131 F = 19 21 * 50yhE N4, 7823 E, GutJWn1G L.i.te.
UP. = 18 So CONY( VL-VEZe-O' 5 (•$.5-s
t S• Oo
DEPARTMENT APPROVALS
•
•
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
I
Ininutetrerwit
_
(Indicated approvals required In either "release" or "release with conditions"
space prior to permit issuance.)
Release
Release
w/cond 1
Hold 2
dEnvironmental
Health 0 Commercial; 0 Residential
W. 1101 College 0 New Construction; 0 Bldg alteration/addltion
Room 200 0 Additional structure;
y
v` w -
FtW k
APPLICATION # if --/d/
Condltions/Commen, .._....i ( ' l '
,,,1 /'
/
f
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 0 new access/approach; 0 fence;
Ir
"8.- /
drainage
❑ road improvements AIAt�A
Conditions/Comments• r -sag
.4I41
E1
Utilities:
N.811 Jefferson
Conditions/Comments.
Other:
V\71
Plan Exam
,.
y
Fire Prov.
0
%% �
Conditions/Comments• �t)O'4/.1f `I( L.,r+I/ rb*L/d L1 a LAViC, a.,
R..P(gc.Acint Sled Ut t4/c l
Information r MDI
. Project Representative Telephone
Agencies Performing Special Inspection:
1
2.
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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PINES FIRST
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