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1984, 10-09 Permit App: 00002750 PoolBUILDING 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) Department Use Only %ww�� / �( V G/ 1 � � k06-14 t Re. I Comm 2 Project Address (not Mailing Address) or Road Name Space Zip o LL E_ , BD®iL)5 ql-F--6y2-9 L/ t� 3 GtylCommunit Kr State W Ft, Subdivision/Plat Name 4 Assessor Parcel No. ©P C ^',/1/ d Lot Block * * * DEPARTMENT USE ONLY * * * 5 Sic Cde'�ri�L– o Zone Act. 0 Zone Project No. 6 Dwell 0 No. of Buildings Sq. Ft./Acre DepthFrontage 3(s So 7 $et Front (L)S-1 i (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 el-Cc7—o M i LS Street Address 0 l 19 ,•1 s ft N. ;#1?t„,..,4 City 5'PoK State I47 Phone (Se9') 9v/-.5-2_7? Contact Perso License No. Phone If diff t than above ( 8 Owner/Agent (if different than 01 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (Y/N) Other (YIN) SEPA Exempt (Y/N) Date 15 Type Work ❑ Bldg 0 Fire ❑ MH 0 Demo l(New ❑ Add/Alter 0 Replace 0 Move �f�AA Oth��j[ M /� 4 t iN 9, 40:_b44,) 14 Describe Work 10 Ap- nt Name i^ Street Address 11 Zip City State Phone Lender Street Address Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Informati n� / 0 f ^" a Application Type (Standard unless otherwise indicated) Fast Track Early Start DEPARTMENT APPROVALS This is nota 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; ❑ Additional structure; ❑ Residential ❑ Bldg alteration/addition APPLICATION # Release Release w/cond 1 Hold 2 Conditions/Comments• Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage; N. 721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU, variance, zone change; shoreline; ❑ fence; ❑ Other Conditions/Comments• Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; N. 811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ road improvements Conditions/Comments• Utilities: N. 811 Jefferson Conditions/Comments• Other: Plan Exam Fire Prev. Conditions/Comments• Information 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 'COUNTY HEALTH DEPARTMENT N° 64 DATE L fir SS K% APPLICA5 N FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES Address./ 3 ` Division of Sanitation I I27 W. Mallon Avenue Spokane I I, Washington Name.._ Address of Propos Site. hone No Z'2.— E QE1t .e Size of Pro rty_. %._a.L.A_.t5 Type of Use____...___. e i t eki c_ a Other Number of Bedrooms Building Capacity Camp Capacity Other Is property below grade c. -,f streets or alleys' A. str oto graded n? Is basement for building planned?How much excavation or fill proposed/ Water SupplyA �"evil Lv Septic tank capacity V /l 51 Length of disposal field / 6__C) _ (City, Well, Spring). gals. Style of tank (1) Draw in property area to scale. (2) Show relative location of: Proposed house, septic tank, disposal field, well, garage, and other out buildings. (3) Make note of any heavy slope or swampy area or any other important topographic details. Date when test hole will be ready for inspection Date installation will be ready for final inspection (that is, before backfilling) sr _Dry vie / /0 t, , .I. Coe.. -9I. SANITARIAN'S REPORT AND RECOMMENDATIONS: Topography Date of Inspe Ground Water Soil Condition Percolation t sts: Minutes Special Recommendations Final Inspection Date Remarks: RECOMMENDED PERMIT BE_ ...... ___...._._............. Sanitarian By. -. _ - __ _•_ (Form 346—Health--2 %M-9-50)