1972, 11-03 Permit App: J4935 MH4117
County of Spokane, Washington
BUILDING CODES DEPARTMENT, COURTHOUSE, SPOKANE, WASHINGTON 99201
APPLICATION FOR LAND USE OR STRUCTURE PERMIT -
GENERAL REQUIREMENTS PERMIT FEE
PERMIT REQUIRED. A land use or structure permit is required by County Resolution to erect a building or. structure of any
kind or alter any building or structure already erected, or to change a land use. Construction must conform with the
Spokane County Building Code and Zoning Ordinance. Construction is subject to inspection.
WATER. Water supply must be approved by the County and State Health Departments. Where work onvater connections disturbs
the surface, shoulders or ditches of County Roads, permission must be obtained from the County Engineer's Office.
SEWAGE SYSTEM. Permits are required in all cases by County Resolutions Nos. 45-133 and 47.235.
SET -BACK FROM PROPERTY LINES. In most zones and under most circumstances, a set -back from the front property line, of at
least 25' is required, a 5' side yard, 15' side yard from a flanking street, and a 25' rear yard are required.
STATE HIGHWAYS.= Where thestructure abuts a State Highway, clearance must be obtained pertaining to set -back and ingress
and egress.
COUNTY ROADS. Work on street right-of-way may not be performed until staked by County Road Department and work must be
performed in accordance with stakes. Points of ingress and egress must be approved by the County Engineer.
MOVING OF BUILDINGS. A permit is required to move an existing building. When a building is moved on a County or State
Highway, clearance must be obtained from the County Engineer and/or State Highway Department.
ACCESSORY BUILDINGS. Accessory buildings (garages, sheds, etc.) require a separate permit.
RESTRICTIVE COVENANTS. Builders should check provisions of covenants or dedications and easements running with the land
which are enforceable through civil action. County Officials can not bring action to enforce covenants or dedications.
Name of Owner`1�-----" " - ` ddress /..
Architect PhoneEngineer Jr, - Phone
Le'
Contractor Address Phone
Legal Description of Property (Give colete descri.tion from deed, tax receipt, etc.)
. APPLICANT FILL IN BELOW THISINE
/ /
Phone IC4' cif
2
y
DESCRIPTIO OF WORK: New Addition�T Remodel Moving Bldg. Zon
Size of Lot , ,f OC--CaL.t e'.�[ Sewage System
Constr- 'r77tC( Dimensions Y r ________________________Total Sq. Ft.
(Frame, concrete, br ck,etc.) /�'tr
Rooms Baths /z J' Basement Foundation Const ` JAN -i''�-Q -p ` Chimney Fireplace
-(Full, part, none) (Kind) (Number)
Heat. SystType of Roofing Ext. Finish Int. Wall Finish
Use of Bldg. --674-4-1-e-%--9--674-4-1-e-%--9/[-� q s /LP -Y.' . No. of Units Bedrooms
Fire Zone 3
Stories %
Valuation g c- n ��
/
uruge or Carport. Attached
PLOT PLAN
Draw sketch with dimensions showing: (1) property lines; (2) street or road locations; (3) location of existing and
oposed buildings; (4) distance to property lines and streets; (5) dimensions of buildings; (6) location of sewage sys-
em and water supply lines.
Private Dotntehed
rn
N
NORTH
SOUTH
1 /— 7 2- 7V2a'K-'(4
REQUIRED
Plumbing Permit
m Heating Permit
NSewage Permit
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
I hereby cert'. y information , ubmitted is correct and there are no other structures located on this property except
as shown. /
Own- or Agent Date
A LAND USE OR STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOT A PERMIT.
/ 0
o' 1444 47(g) DORI
NOT WRITE BELOW THIS LINE �}
Your street address will be / 73 2 I Lam/ .et -e) ` The zone is
Sewage Permit Number Issued Building Permit( /Receipt
Remarks
sued
Form 523 Bldg. Code