1984, 06-19 Permit App 00000739 GarageBUILDING 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 Name (last) _(firs) (m) Department U Only
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2 ' t Address (not Mailing Address) orMd Name Space Zip
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State I
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Subdivision/Plat Name
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4 Assessor I No. �y
3 a 5� 5- a Q
Lot
Block
* * * DEPARTMENT USE ONLY * * *
1 5 Sic Code
Zone Act. #
Zone c
Project
- 6 Dwell #
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front
(L)S-1
(R)5-2-, (
iG
1Rear
(knsus Tract
I Module No. Fl
t 16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
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Street
CPhone
Address
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Zip
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Contact Person
License No.
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Phone If different than above
( )
8 Owner/Agent (if different than #1 above)
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Business
Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan
grip& (Y/N)
Other
(Y/N)
1SEPAExempt(Y/N)
Date
15 Type W rcgf K.
❑
Bldg
Fire
❑ MH
0 Demo
New
0 Add/Alter
❑ Replace
0 Move
❑ Other
14 Describe Work
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10 Applicant "
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Street Address
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11 Zip /
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v
State • Phone •
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Lender
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Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
Application Type
(Standard unless
otherwise indicated)
Fast Track
early Start
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
Conditions / Comments-
❑ Commercial; Residential
❑ ,f4ew Construction; 0 Bldg alteration/addition
/ Additional structure;
APPLICATION If
Release
Release
w/cond 1
Hold 2
❑`
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N.721 Jefferson 0 Setbacks; ❑ lot wfd; ❑ lot size; ❑ use/zone;
❑ CU, variance, zone change; shoreline; ❑ fence;
O Other
Conditions/Comments
Engineers: ❑ Commercial; 0 Residential;
N. 811 Jefferson 0 drainage 0 new access/approach;
❑ road improvements
Conditions/Comments
❑ Flood Plain;
O fence;
Utilities:
N. 811 Jefferson
Conditions /Comments•
Other:
Plan Exam
Fire Prev.
Conditions/ Comments•
cat
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
STEEL
BUILDINGS, INC.
N. 10111Newport Highway • Spokane, WA 99218 • (509) 487-7090
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