1986, 08-29 Permit App 00012892 Carport(THIS IS NO1 A PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE 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 //� /) 2
G-T�`�
Owner's Name LAST FIRST MI
Project Address (Street Name & Number) Zip
E . I7G o Cowley Ave lam( . q9or.6
Applicant
Address
City
State
Zip
Phone
( )
Business Phone
( )
ContractVAgent
3riez,-,..e___u
c z4A-e..s
Address
7
e(o E., 13
City
State
Zip
Phone
Contact.
License Number (Required)
SPok AS
1 G * CB
Business Phone
( ) g 2_7- 0i -05'
Architect /Engineer
Address
City
State
Zip
Phone
( )
Contact
Business Phone
i ( )
Lender
Address
City
State
Zip
Phone
Describe Work
Care r�eQ7-(2oX21) OPc->� 4-s:Dr-- S
Res.
`�
Comm_
Subdivision/Plat Name/Short t Number
MEW 4
no Acre
Assessor Parcel Number
i Gss3 -093.7
Lot
3
Block
le
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
,f.
Number of Buildings
2
Lot Size (Sq. Ft./Acre)
Depth
i54
Frontage
72-
Front Setback
5s
Left Setback
Right Setback
1i
Rear Setback
R/W Width
Additional Information
Square Footage
� �/
A2-LJ
Z
0
m
cc
0
u.
Z
0
_z
.-!
5
5
00
Number of Bedrooms
Building Techr+ an
Date
Group
Type
Show on Site Plan:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
Legal Description
Scale:
Date:
Revisions:
Attachments:
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E. 7406 SPRAGUE, I#3 • SPOIIKANE, WA99212 •1(509) 927.0655
41 + - 4 1 -' 7 I
/ Environmental Health
W. 1101 College
Room 200
DEPARTMENTAL REVIEW
Application 0 jg — ✓
Approved
Cond.
Approval
Hold
Planning/Zoning
❑ N. 721 Jefferson
Engineers
0 N. 811 Jefferson
Utilities
O N. 811 Jefferson
Plan Review/Fire Prevention
❑ N. 811 Jefferson
0
Other (SEPA/Critical MaterlaUetc.)
Fast Track/Special Inspection Information
Protect 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 compile said application is true and correct.
Signature Date