1984, 09-10 Permit App: 00002195 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
Ras. Comm
2 Project Address (not Mailing Address) or Road Na e
2Si 3 �. u,
Spm �ZZ �2�Z3
# Zig.
4
3 City/Community
State
.7
SubdlvisionlPlat
Name i c S IlZ D l'/U
4 Assessor Parcel No. /�
2-v s-4- ._.. p� / 7 �/
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Lot
_1'y
Block
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* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act. N
Zone �-^
J rp
Project No.
6 Dwell if
No. of Buildings
Sq. Ft./Acre
Depth
l '
Fron ge
7 Set Bads-Fron
6)
(L)S-1
S
(R)S-2 iRear
(C
S -D
Census Tract
Module No.
Initials
—JO tJ rev)
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
ell—r�i+,,RS
Street Address
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Zip9 J 6
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V
State
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Phone (9 ) 9 -�Z7 y
ZntacAlersor,
License No.
e sm, /f / N'
Phone Ifdifffere
( )ntthan above
8 Owner/Agent (if different than M1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work ❑ Bldg
❑ Fire
❑ MH
❑ Demo
New
❑ Add/Alter
E Replace
0 Move
❑ Other (--)AV &�
S w/$f race
14 Describe Work
Sa/ii sem-,MM /A I-- Az, 1....
10Street
pplicant Name
ti► S g,� s LJ
Address
11 Zip CX -t.„--,
"X'a.�
�C�itty(��/)��c-4.
State
Phone
( )
e V �r ��
Lender
,
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Additional Information
/7x 27 Peon 0 v)4L.
DEPARTMENT APPROVALS
•
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Release •
Release
w/ • • nd 1
Hold 2
Environmental Health ❑ Commercial; ❑ Residential
W. 1101 College ❑ New Construction; ❑ Bldg alteration/addition /
Room 200 ElAdditional structure;
'
f -
/�
APPLICATION # CC/ ✓/
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; 0 fence;
I
0 road improvements
Conditions/Comments.
Utilities:
N. 811 Jefferson
Conditions/Comments.
III
Other:
•
Plan Exam
Fire Prev.
Conditions/Comments
IInformation ❑
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
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.SPOKANE COUNTY HEALTH PI -S -T'. RFIGT;10/
_4_,
• ". ..-' ' .0 J,4 4- ,,,,,••• ."-- .4.,..- 44'. r -..?
E. 0. PLOEGER, M. D., M.P.H., HEALTH OFFICER
N. 819 Jefferson Street
••••• - • .
, e."':,3•4,-.. •,,, .,,,:,s• -.4, -,1 ' i'4,
Spokane, Washington 99201 ‘
•
PERMIT NO.
r
Name
DAT
7-
N9 09324
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DI POSAL FACILITIES
idient-QOAS)
ANO Phone No.
Address of Proposed Site
Type of Use deflA2.00
Number of Bedrooms Building Capacity Camp Capacity
Drywell
Septic tank capacity gals. Style of
Length of disposal fiel. ; b
AO /
sorption Pits
(1) Show relative location of: Proposed house, ptic tank,
disposal field. well. garage and other out uildings.
/39
AP
An
---11••••:•••••.'_....d4
Address
Ts basement for building planned')
Water Supply
(City, Well, Spring).
0
Teach Bed -
(2) Make note of any heavy slope or swampy a -a or any
other important topographic details.
- •
Installer
7-14/
Final Inspection Date
Remarks -
ii
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-t-'--CONTRACTO
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!ORM, 146fRIV•KEALTW
- ForSpokaneCountyHealthDistrict
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