1984, 07-19 Permit App 00001289 MH VoidBUILDING PERMIT APPLICATION WORKSHEETDDO
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)
8 Owner/Agent (if different than #1 above)
C_ ✓ S ' �.
9 Zip City
12 Review Required Plan Check (Y/N)
15 Type Work ❑ Bldg ❑ MH
❑ Fire ❑ Demo
14 Describe Work
` /✓tom b . - ! � ),� � �-.-t
10 Applicant Name
11 Zip
City
Lender
Zip
Contact Person
Additional Information
Phone if different than above
Business Address
State Phone
( ) 9 -2- V 2-
(Y/ N)
(Y/N) SEPA Exempt (Y/N) Date
❑ New ❑ Replace ❑ Other
❑ Add/Alter ❑ Move
70 3/ 8 s 0i, -s ti &-,* Nc J2 4.
Street Address
State
I ( )
Street Address
Phone
Phone if different than above
w
(last)
(first)
(m)
Department Use Only
o f e r 5
101 VI
C'
Res. Comm
2
Project Address (not Mailing Address)
or Road Name
Space
315- S. /,
0
Zip
3
City/Community
State
Su bdlvislon/Plat Name
/ gS-/ 6, - % ti L
c fJ -__
p
ar#a ,zcJ, ✓ /t5�'s r'g pfi r7�
4
Assessor Parcel No.
Lot
Block
* ♦ * DEPARTMENT USE ONLY ♦ #
5
Sic Code Zone Act. #
Zone
K�
Project No.
t.2,
6
Dwell # Buildings
Sq. Ft./ Acre Depth
ry [No.
Frontage
S 7iS Q
7
Set Back -Front (L)S-1
( )S-2
Rear
(bnsus Tract Module No. Initials,
�IJN i11
16
Architect Firm Name
Street Address +
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
Contractor Firm Name
Street Address
Zip
City
State
Phone
8 Owner/Agent (if different than #1 above)
C_ ✓ S ' �.
9 Zip City
12 Review Required Plan Check (Y/N)
15 Type Work ❑ Bldg ❑ MH
❑ Fire ❑ Demo
14 Describe Work
` /✓tom b . - ! � ),� � �-.-t
10 Applicant Name
11 Zip
City
Lender
Zip
Contact Person
Additional Information
Phone if different than above
Business Address
State Phone
( ) 9 -2- V 2-
(Y/ N)
(Y/N) SEPA Exempt (Y/N) Date
❑ New ❑ Replace ❑ Other
❑ Add/Alter ❑ Move
70 3/ 8 s 0i, -s ti &-,* Nc J2 4.
Street Address
State
I ( )
Street Address
Phone
Phone if different than above
w
DEPARTMENT APPROVALS
Th'Ii;s not a Permit
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
s
Application Type
(Standard unless
(Indicated approvals required in either "release" or "release
with conditions"
otherwise indicated)
space prior to permit issuance.)
Fast Track
I Release
Early Start
Rele'a_sel w/cond 1 Hold 2
Environmental Health
W. 1101 College
❑ Commercial; ❑ Residential �N
❑ New Construction; ❑ Bldg alteration/addition
Room 200
❑ Additional structure;
APPLICATION # 7
Conditions/ Comments:
Planning /Zoning:
N. 721 Jefferson
E-1 Commercial; ❑ Cert. of Exemption;
❑ Setbacks; ❑ lot w/d; [-I lot size;
❑ Frontage;
i
❑ use/zone;
❑ CU, variance, zone change; shoreline; ❑
fence;
Conditions/Comments:
❑ Other
C
L ) c
Engineers:
❑ Commercial; ❑ Residential;
❑ Flood Plain;
N. 811 Jefferson
❑ drainage ❑ new access/approach;
❑ fence;
❑ roa improv ments
Conditions/Comments:
Utilities:
N. 811 Jefferson
Conditions/ Comments:
Other:
El
Plan Exam
Fire Prev.
Conditions/ Comments:
0
Project Representative
Telephone
i
Agencies Performing Special Inspection:
=
1.
o
o is
= E
2
0
o �
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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BLACK
7O -O376 468239C
BEN C PETER%
TOTAL C^FIRE: C^WEED
_BLT
��
FIRE Inrxu«E»
U�IMPROVED
TOTAL
LAND IMPR
84/22/77 TAX
UNPD
°~
ACRES ACRE% VALUE
ACRE%
VALUE
ACRE%
VALUE VALUE
TOTAL
U FIRE^OO ^80 ^O�
U^WEED
^OO
AIR SPR DK CPT GAR %MP USE UNTJ
LOT %IZ L.AREA ACRES J.
z0UC.)8
5.25
208O0 25900
VALUE
)i !F..'
EX CODE
^
5 ^J
5^25
2080O
5.25
101900O8 OO 25p�O
467O8
84
264
_
�0O5^25
K7
20880
2O8OO 259"O
467
0002808 0802888
264
pT5 OF /4 OF NEI
ZONE
HEAT ROOF JIDE APPRAI%ER
467O8|
�~
NEj/4 OF %EC 19 & F` TN OF %Wi/4
OF
N41/4
OF NWi/4 DAF/ BEG
/
AT |
WILY COR 1 2 NO WE%T
DIS HMAN
TH WLY
A
LN OF JWi/4 OF NWi/4
!
NWj/4 OF JEC 2O & %
LN OF %E
i/4 OF
NEi/4
OF NEI OF %EC
OF
350FT TH NWLY TO PT
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EXT OF
L B 1 WE%T DIJHMAN PT
jq
BEING E /
i9546-9iO6
i9546-9iO6
232 % DI%HMAN RD
%POKANE
%POKANE WA
992O6
RD
�
TOTAL C^FIRE: C^WEED
_BLT
REM %T RM% BDRMJBTH% B -MT
CONE ABEA COND FP RO DW
GD WW RR
46700 5.35
^
6i5 55
C/�
/z n/ «"
F O0002"340 i
BB
%J pAT IN
T -
3O7.77
264U.FIRE U^WEED
^
UNPD.TAX EX CODE YR JT
"
U FIRE^OO ^80 ^O�
U^WEED
^OO
AIR SPR DK CPT GAR %MP USE UNTJ
LOT %IZ L.AREA ACRES J.
DATE J PRI^
E i%
m�
%E
069
0O525
^
AFF O
�- '^' "
2 NEi/4�F FEC' i9 &
`
pTN OF %Wi'/4 OF NWi/PTNFOF
DAF/ BEG AT
D 84
WLY COR L2 BiO WE%T
DI%HMAN THWLy AL��%ULNNWi/4
BLD i
VAL BLD 2 VAL BLD 3 VAL
8021100
0002808 0802888
ZONE
HEAT ROOF JIDE APPRAI%ER
�
43
31
/
i9546-9iO6
i PETER% BEN
C'
J 324 DIdHMAN
%POKANE WA
992O6
RD
O63O82 LANDIMP%
TOTAL C^FIRE: C^WEED
CERT^TAX U.FIRE U WEE
EX CO O OD 2OGV �z�o
46700 5.35
^
6i5 55
UNpD TAX
^
264 28888 2 598O
.26
467OO O8 OO
2 68
^ ^ ^i
3O7.77
264U.FIRE U^WEED
^
UNPD.TAX EX CODE YR JT
"
U FIRE^OO ^80 ^O�
U^WEED
^OO
Y %T
^ UNPD^
X EX CODE
m�
PETER%
%Ei/4 OF NE1/4 OF
|
2 NEi/4�F FEC' i9 &
`
pTN OF %Wi'/4 OF NWi/PTNFOF
DAF/ BEG AT
D 84
WLY COR L2 BiO WE%T
DI%HMAN THWLy AL��%ULNNWi/4
U� %Wi/4 OF NWi/4