1985, 04-03 Permit App 00004759 AdditionI
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 j `(last) irst) 1�
( / S �n P /' L
(m)
impartment Use
Ras. Comm
2 Project Address (not Mailing Address) ore S ace
s� elf /D a4DUJA V
Zip
3 Ci munity State
e?e - � �
Su Ision�/ew� Name
/,
4 Assessor Parcel No.
Lot
//
Block
DEPARTMENT USE ONLY + + +
5 Sic Code
Zone Act. If
Zone Project No.
6 Dwell M
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Font (L)S-1
(R)S-2 Rear
Census Tract
Module No.
InitialJ�.
t 16 Architect Firm Name MENNEN
'--7b-� C—
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone If different than above
( 1
ntractor Firm NameStreet
-R��s1ti �� �'/�/.
Address
61a6 3 �s �`—
Zip
State
Phone
—Contact P,gson / /
License No.
l°j2CCIl l9/ iC
Phone if different than above
6 Owner/Agent(if different than above) /y
V Q
Business Address
9 Zip
City
State
Phone
1 )
12 Review Required
Plan Check (YIN)
Other (YIN) SEPA
Exempt (YIN)
Date
15 Type Work Bldg
El Fire
Cl MH
❑ Demo
❑ New
6//Cddl Alter
❑ Replace
❑ Ma,e
❑ Other
14 Describe/W�ork
16.�
10 Applicant Name
Street Address
11 Zip
City
State
Phone
Lender
Street Address
Zip
City
StatePhone
Contact Person
Phone if different than above
1 1
Additional Information
All
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
Environmental Health
W. 1101 College
Room 200
Conditions/Comments.
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
❑ Commercial;
❑ New Construction;
❑ Additional structure;
APPLICATION # A f / box
❑ Residential
❑ Bldg alteration/addition
Rel -see
Release
/cond 1
Hold 2
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; ❑ lot wld; 0 lot size; 0 use/zone;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions/Comments.
Engineers: 0 Commercial; 0 Residential;
N. 811 Jefferson 0 drainage 0 new access/approach;
O road improvements
Conditions /Comments -
❑ Flood Plain;
0 fence;
Utilities:
N. 811 Jefferson
Conditions/Comments •
Other:
Plan Exam
Fire Prev.
Conditions/Comments.
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
E. 6203 Desmet • Spokane, WA 99206 • (509) 534-5950
0
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t70.37/13