1985, 05-30 Permit App 00005429 DuplexBUILDING PERMIT APPLICATION WORKSHEET 1/6
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) (first) (m)
�(j�-Fl.►a 7M�.Qyti‘{
Department my
fps.
Comm .._
2 Project Address (not Mailing Address) or Road Name Space Zip
E . IO 4 l? - 1 q ' i'z- PAT;;'a:�fa�(
3 City/Community
‘-'1'c744,40.1vE
State
Subdivision/Plat Name
tr'7PrC>i=-;-.LAN c l
4 Assessor Parcel No.
11541 • , r�zG
Lot
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. #
Zone ``,,
A SVp
Project No. `q
!
6 Dwell #
-
No. of Buildings
1
Sq. Ft./Acre
Depth
3 �
Frontage
Go'-2‘5"
7 Set Back -Front _
(L S-1
II
(R)S-2
Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Firm Name
V\Ie— Lt41v0 .v.cpr7N1
Street Address
5.-1i, 1Ne j
Zip
�C�Zv%
City
'State
Phone
(5C'') e12&;-- Z'j4z
Contact Person
License No.
Phone if different than above
8 Owner/Agent (if different than #1 above) i t> iz-) '
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (YIN)
SEPA Exempt (Y!N)
Date
15 Type Work I3/Bldg
0 Fire
❑ MH
0 Demo
❑ New
0 AddlAlter
❑ Replace
0 Move
❑ Other
14 Describe Wor
Pub
10 Applicant Name
(2,,C.),.>'t2 A c7CO2
Street Address
11 Zip
City
State
Phone
( 1
.1Lender Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
IA F 1440
0
iFz 193B13
05 = !44o )
P K i 3 20 TS
ty(
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is nQt a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
❑ Commercial;
D New Construction;
❑ Additional structure;
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
\1;-1 L6 lill
.
APPLICATION #
Conditions/Comments.
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; ❑ lot w/d; ❑ lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments.
Engineers: 0 Commercial; ❑ Residential;
N. 811 Jefferson 0 drainage ❑ new access/approach;
O road improvements
Conditions/Comments.
/ /V4 5;1
❑ Flood Plain;
O fence;
Utilities:
N. 811 Jefferson
Conditions/ Comments•
Other:
Information
Plan Exam
Fire Prev.
Conditions/Comments'-lb '1VLIai.►
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
L
F,i/1SNso
ry FLoclL � >j1%
f
nay
b
y$ �
/P a:,
G�e57C'D000, iW
i PWe^�k%e-
f Pvegnv�D-
3� V SSR 3S
f Arse
yq
DC-cK
DQ%v6
35,
/yy Goy
DRJtJE
$LoOE
�
ly,r��t
3LOOG
&o.
M
' I
LAJ L/fJ 1
[ Tv a fJ VY1
I�1Qout/j .
OPPORTUNITY W 40 FT. OF THE EAST ;I L 1 BLOCK 67, EXC. CO. RD.
SPOKANE COQNTY WASHINGTON
'W
5} I