1997, 09-09 Permit App 97006900 Safety InspectPROJECT NUMBER= 97006900 APPLICATION DATE= 09/09/97 PAGE= 01
PROJECT NUMBER= 97006900 APPLICATION DATE= 09/09/97 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 14623 E BROADWAY AVE PARCEL#= 45142.9235
ADDRESS= SPOKANE WA 99216
PERMIT USE= SAFETY INSPECTION OF STGE TO RES & BREEZEWAY ADDITION FOR DUPLE
PLAT#= 999999 PLAT NAME= RANGE
BLOCK= LOT= ZONE= JU 3 . 5
AR $0-Qe0-0-0 66OF/A= A WIDTHS 6-8
# OF BLDGS= 2 # DWELLINGS= 2 WATER DIST
OWNER= SCANIO, RITE & DAVID
STREET= 14623 E BROADWAY AVE
ADDRESS= SPOKANE WA 99206
CONTACT NAME= DAVID OR RITA SCANIO
BUILDING SETBACKS: FRONT LEFT=
*** REVIEW I
***************************
DEPARTMENT
DIST#=
DEPTH=
F
200 R/W=
PHONE= 509 891 8284
PHONE NUMBER= 509,891 8284
RIGHT= REAR= itg-
FORMATION *********** ******************
REVIEW REQUIREMENT
BUILDING FIELD INSPECTION
COMMENTS : � 9p41
p /
BUILDING SETBACK REVI QUIRED
COMMENTS:
HEALTHDIST NEW OR ADDITIONAL WASTE WATER
COMMENTS:
HEALTHDIST INCREASE IN LOT COVERAGE
COMMENTS:
f-D
PLANNING ADDIITIONAL DWELLING
COMMENTS: LS 1L r2L�
******************* *********** BUPLDING
CONTRACTOR= OWNER
ERMIT
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044,en
******************************
PHONE=
NEW= REMODEL= X
DWELL UNITS= 1 OCCUP. LD=
ADDITION= CHANGE OF USE=
BLDG HGT= 16 STORIES= 2
BLDG W X D = 34 X 56 SQ FT= 3808 SPRINKLER= N
PROJECT NUMBER= 97006900 APPLICATION DATE= 09/09/97 PAGE= 02
REQ PARKING=
ITEM DESCRIPTION
#HANDICAP= CRITICAL MAT= N
QUANTITY FEE AMOUNT
CHANGE OF USE/SAFETY INSP Y 50.00
************************-k****** PAYMENT SUMMARY ****************************
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
09/05/97 00008551 50.00
TOTAL DUE= .00 TOTAL PAID= 50.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
BUILDING PERMIT 50.00
50.00
PROCESSED BY: JULIE SHATTO
PRINTED BY: JULIE SHATTO
******************************** THANK YOU ************************************
50.00 .00
50.00 .00
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Notary Public (Washington): Notarizing Documents
May 10.1990
8544.5
Exhibit 1: MSG Form
Certificate for Individual Acknowledgement
State of Washington
County of
On this 1t day of , 199 7_, before me, a Notary
Public in and for the State of Washington, duly commissioned and sworn,
personally appeared .1) b R Ye. tin.) s , to me known
Name of Person
ss
or proven on the basis of satisfactory evidence to be the individual who
executed the within and foregoing document, and acknowledged the said
instrument to be4'h�� ►free and voluntary act and deed, for the uses and
purposes therein mentioned.
GIVEN UNDER my hand and official seal hereto affixed the day and
year in this certificate above written.
Photocopy as Needed
Notary Public in andor the
State of Washington, residing at
My appointment expires:
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a'`�o sip FcbGO
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Management and Start Guide
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SEP-25-1997 13:49
PROJECT N Jb BER= 97006900 AP'cL'ICAWION
PROJECT NUMBER', 97006900 APPLICATION
DATE 09/09/97
DATE 09/09/97
P.01
PAGE- 01
PAGE 01
****•* THIS IS NOT A PERMIT
PENALTIES WILL BE ASSESSED FOR cOWNENCING WORK WITHOUT A PERMIT
SITE STREET=
ADDRESS=
PERMIT USE=
14623 E BROADWAY AVE PARCELO= 45142.9235
SPOKANE WA 99216
SAFETY INSPECTION OF STGE To RES 6 BREEZEWAY ADDITION FOR DUPLE
PLATO- 999999 PLAT NAME=
BLOCK= LOT-
,O QF/A-
# OF BLDGS= 2 # DWELLINGS=
OWNER- SCANIO, RITE 6 DAVID
STREET- 14623 E BROADWAY AVE
ADDRESS- SPOKANE WA 99206
CONTACT NAME DAVID OR RITA S IO
BUILDING SETBACKS! FRONT= LEFT-
•• REVIEW I
i*■.s*ii...** ***
RANGE
ZO+iE- 3.5 DIST*= F
A WIDTH) DEPTH= 200 R/W=
2 WAT DIST =
RIGHT-
FORMATION 4i
DEPARTMENT REVIEW REQUIREMENT
PRONE- 509 891 8284
PHONE NUMBERaa 509 891 8284
REART„.""s'A
n
BUILDING FIELD INSPECTION
COMMENTS:
L2 • �2 (�{�
'1 1e-- E10 teta
BUILDING SETBACK REVI
COvAr.NTS :
HEALTHDIST
COMMENTS:
HEW OR ADDITIONAL WASTE WATER l�
HEALTHDIST INCREASE IN LOT COVERAGE
COMMENTS:
PLANNING ADDITIONAL DWELLING
COMMENTS: AL
CONTRACTOR= OWNER
N
DWELL 0NITS= 1
8 2LiDING •£RMZT
REMODEL- X
OCCUR,
PRONE -
ADDITION= CHANGE OF USE=
BLDG HGT- 16 STORIES2
TOTAL P.01