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1984, 05-31 Permit App 00000423 Addition
BUILDING 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) hSo.17), 2 Project Address (not Mailin dress) or Roadyame . /'9/-t.) GrJc�Yr (first) Space (m) Zip Comm 3 Clty/Communittyy y C iie Stag, )i /} GU,4 Subdi 's'on/Plat Name Gince-, h G ()PS 4 r Parcel No. Lot / Block * * * DEPARTMENT USE ONLY * * * / / Q .5-53 - 10 // 5 Sic Code Zone Act. # Zone Project No. 6 Dwell # No. of Buildings 1 Sq. Ft./Acre Depthth 40 Frontage (a®' 330 7 Set Back -Front (L S-1 s ' ��' (R)S-2 Rear 1 1�1 j1a Census Tract Module No. Initiate ��o N1. Street Address Zip City State Phone Contact Person Phone If different than above Contractor Firm Name Street Address Zip City State Phone ( ) Contact Person License No. TR t ter Phone If different than above ( ) 8 Owner/Agent (if different than #1 above) I( W�� Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (YIN) Oth r /N) I SEPA Exempt (Y/N) Date 15 Type Work ©Bldg ❑ Fire ❑ MH 0 Demo ❑ New 0 Add/Alter ❑ Replace 0 Move ❑ Other 14 Describe Work 10 Applicant Name pZ r L cm 5 City C C. 1 Lender C C€ "C -State Street Address gZix;2o3 J CinEAt • Phone (5JCt) ,3 c/- g l5'C) Street Address Zip City State Phone ( Contact Person Additional Information ffr estCt, S7Z w1F 0 �S • Phone if different than above 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 ❑ Commercial; ❑ New Construction; O Additional structure; ❑ Residential ❑ Bldg alteration/addition APPLICATION # Release Release •> cond 1 Hold 2 Conditions / Com men is• Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage; N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone; ❑ CU, variance, zone change; shoreline; 0 fence; O Other Conditions/Com ments• Engineers: ❑ Commercial; 0 Residential; ❑ Flood Plain; N. 811 Jefferson 0 drainage ❑ new access/approach; 0 fence; ❑ road improvements Conditions /Comments• Utilities: N.811 Jefferson Conditions/ Comments• Other: Plan Exam Fire Prev. Conditions/Comments' 0 c o 0 t- E O u_ 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 PRECISION BILT STEEL BUILDINGS, INC. N. 10111 Newport Highway • Spokane, WA 99218 • (509) 487-7090 Qo d G :LsaN 7 /G/« 4it/rS5-3 /o// E. /2evo hoc /// iS7o<Jc &'ect ,ALI eft 5J(. fV 72 r— in 75 • /oo r nogoSEo nalTref IC' • Nl /3Com O WA