1985, 04-16 Permit App: 00004966 ResidenceBUILDING 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) (first) (m) r Department Use Only
.,.."-6%C6 ��//_,J% f R.3. Comm
2 Project Address( t ilin9 Address) cr Road Nam Space Zip
.0J IL S 7- p ‘ zcg
3 City/Community
State
Subdivision/Plat Name
4 Assessor Parcel No.
/G/ S , , l v 9..2.0-I
Lot
Block
,t . * DEPARTMENT USE ONLY * * *
5 Sic Cade
Zone Act. #
Zone /q
6 ----C
Project No.
4
/
f�
6 Dwell #
I
No. of Buildings
Sq. Ft./Acre
Depth
12-1 l
Frontage
oQ
7 Set Back -Front
`30 '
(L 5-1 I
3 2
(R)S-2(
Rear 1
55
Census Tract
Module No.
l
Init' Is
J UK) ae) .
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
ContractorFirmFirm Name
s/ 7-7 /i G.-. Tai Z
Street Address
Zip
G
State
Phone •
Contact Person
'212/C .��%/
License No.
,M4 11! 5 S *i6,
G
Phone If different than above
( )
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
I SEPA
Exempt (YIN)
Date
15 Type Work Bldg
❑ Fire
❑ MH
❑ Demo
New
❑ Add/Alter
E Replace
E Move
❑ Other
Describe Work
RiS14
cPG41c-- (to &,‹17,10.,&)
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information 1
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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"
pace prior to permit issuance.)
cRJ
cD
Environmental Health 0 Commercial; 1=1 Residential
W. 1101 College 0 New Construction; 0 Bldg alteration/addition
Room 200 0 Additional structure;
APPLICATION # ,S/ 3--, •"2W-
Release )<
Release w/cond 1 Hold 2
IBMTIMT.1
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; D lot size; 0 use/zone;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions/Comments:
1-21-
* off I
etfewhiect
Engineers:
N. 811 Jefferson
Conditioqs/Comments:
el.......“—e 1
O Commercial; 0 Residential;
O drainage g new access /approach;
O road Improvements 7 •
•
O Flood Plain;
O fence;
/ 7D
Utilities:
N. 811 Jefferson
Conditions/Commen)s• fled
5h9fr-kof,-7.- frfpc
Other:
Plan Exam
Fire Prev.
Conditions/Comments:
fZc
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
too ,o'
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TO:
FROM:
SUBJECT:
SPOKANE COUNTY HEALTH DISTRICT
Inter -Office Communication
. DATE:
Spokane County Utilities and Spokane County Engineers
Spokane County Health District - Environmental Health Divisiod
Proposed Building Project at:
p
UTILITIES: Attached is the proposed plot plan denoting the location and installation
specifications for the on-site sewage disposal system. The sewage
system installation permit is being withheld pending your comments and/or
design for the double plumbing to facilitate connection to the future
Spokane Valley sewer.
1. No determinable location for future sewer lateral, therefore, double
plumbing is not required.
(signature)
(date)
2. Double plumbing required. Note location and specifications on
approved site plan.
(signature)
er commentsd/or recommendations.
(date)
s -G -per
(signat ) .41' ,(dat 1
(Please forward this response forr.i to County Engineer if project is a
commercial proposal.)
ENGINEERS: The surface water grass percolation area is identified on the
attached plot plan.
Other remarks:
(signature) (date)
Please forward this form back to the Spokane County Health Distr'ct
the first working day after receipt of information.
ld
Attachments
4/17/85