FANCHER N 110 SNYDERS BAKERY ADDITION TO SHP DEPT
~ (THIS IS NOT A PERMIT)
BUILDING PERMIT APPLICATiON WORKSHEET ~
PLEASE PRINT AND COMPLETE ONLY THOSE, PARTS OF THE FORM YOD UNDERSTAND '
COMPLETE IN INK ~
(Please return thfs original and your building plans to the Department of Building and SaFety)
SHADED AREAS ARE FOR DEPARTMENTAL USE - - ,
ProJect Nurnber
Owner'9 Name LAST FIRST Mi
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Project Address (Street Name 8 Number) Zip
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Apc4nt ` Addrm a W,
City State Zip Phone
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Business Phone
r l ~3 S '-77 Z--~
Contractor/Agent ti
Address
F, iS4 0 -FFZE-f47F
City ~ State Zip ` ~
Phone
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Contact License Number (Required) eusiness Phone
G3 G - g~-7 7
Architect I Engineer ' Address
S 2- ~ PD.
CitY ' State Zip Phone
4
Contact Business Phone
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Lender Address
t
Gty State ' Zip Phone
( )
Res• . Comm.,
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SubdivisfonlPlat Nsmel8hort Plat Ptwnper ' • . ' . ~ , - ~ ,
Le /~S"~ ~ O iG~►~t ~ ' ' ' ~ . ~ , , , , , . :
Amesam Peroel Numbec .Lot . . ' Bloclc ` Plat Number •
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PWtrneM Flle Numbers
Zo^e i Comp. P{an . Censua Trect
Number of D►Mefilng tfilb ~ Number oi BuIIQtnge° Lot S#e (Sq, Fl. f Acre) Depth Frontafle
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Ffont Setbock , Ldt 6etback ~ , . . Rlflht SetDack • - , . Fiesr Seibadc , R! W Width
Additlonal lntormatlon ~ . ~ ~ . - 1 . . ~
, , . , . • _ - ~ ' - , _ , , , . Square FootaQe
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Build(nq Techniclan ~ Dete Group Type
10"_'~,y, ~ ~2-
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DEPARTMENTAL REVIEW
Approved Cond. Hold ,
Approval
/
Environmental Health Application #
W. 1101 College
Room 200
~Planning/Zoning
~ N. 721 Jefferson
/ A
, . . 1J1
Engineera ,
~ N. 811 Jefferson
f .
~ Utllit(es
N. 811 Jefferson
Plan Revlew/Flr vention
\N. 811 Jefferson
Other (SEPA/Crltlcal Materlal/etc.)
❑
N~~•
~ Feat Treck/Speclal Inapectlon informatlon
Project Representatlve Phone
Address I certify that i have e mined thls appfication and state that the information contained in it and submitted
by me or my agent t omp' i s~id applicat is true and correct.
Si natur _
9 , ~ . Date
(THIS IS NOT A PERM{T}
i BUILDiNG PERMIT APPL{CATION 1ILfORKSHEET
.
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF TNE FORM YOD UNDERSTAND
COti1PLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE ~
Project Number Owner's Name LAST FIRST MI
SNYOER 'S BAKERY
Project Add►ess (Strset Naine R Number) ZiQ
N* 110 FANCHER ROAO
A¢plicant Address
City State Zip Phone
( I
Business Phone
( )
ContractorlAgent Address
BALBwrDN S ioNS & 0 iSPLAYS, I NC. NORTN 3502 MARKET STREET
C1ty State Zip Phone
SPOKANE MA. 99207 ( ) 489-9191
Contar.t License Number (Requirecf) Business Phone `
(l tANNA 1 INflt1IST BA-4.D.WS-016601
Architect! Engineer Address
City State Zip Phone
/ ( )
Contact ~ Business Phpne
Lender Address
\
Oty Slale `Zip Phone
Describe Work Rw.- Comm. . .
D/F7'x17 '9" POLE S If3N , \ / •
/ , .
SubdlvlsfonlPlat NamelShort Plat Number Asaesaor Parcel Number Block Wat Number
13533-2306 pertlnent File Numbera v
e Comp. Plan Census Tract
Numbef ot DwelNnp Unlta Numbar of g nQs , Lat Site (SQ. Ft.lAcre) Oepth frontage
- .
Ftont Setbecic Lett Setbaclc ~ Right Setbaclc Rear Setbaclc A/ W Width
. , _
A,ddltionaf fntormatton ~ ~ • . Square Footage • ~ S• 406.5' OF N436.31 OF W600' OF 827 EAST SPOKANE ADD
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Group Type
Buildirtg Techniclan Date ;
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DEPARTMENTAL REVIEW
° Approved Cond. Approval Ho1d
Environmental Health Applicatlon #
❑ W. 1101 College Room 200
Planning/Zoning I❑ N. 721 Jefferson
Engineera r- 30 41,
❑ N. 811 Jefferson S'fN 1Z~1 • ~
Utilities
❑ N. 811 Jefferson
Plan Revlew/Flre Preventlon
❑ N. 811 Jefferson
. ~
Other (SEPA/Critical Material/etc.)
~
❑ Fast Treck/Speclel Inspectlon Intormetlon
ProJect Representative Phone
Address
,
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to complle said applicat(on is rue and correct. '
' • .
Signature ~ ~ _ Date
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