1976, 06-10 Permit App: L4276 ResidenceCmsfy of Spokane, WaAltfon
BUILDING CODES DEPARTMENT, N. 811 JEFFERSON, 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. Constuction mast 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 on water connections disturbs
the surface, shoulders or ditches of County Roads, permission must be obtained from the County ELgineer'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 the structure 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.
APPLICANT FILL IN BELOW THIS LINE
as a
/J h ,�a� 1�c�O
et
J
Name of Owner / _ :# , ,- ./ /'. Address ,t itl) i e-ot g ` Phone -2-9 i'- ..34-9
Architect Address Phone
Engineer)) Address Phone
Contractor QO/!/N4.ei AddressPhone ts
Legal Description of Property (Give complete description from deed, tax receipt etc 1 „.211.4/V-1-, o 9 .417 - /ITD
1.4 TS /34-t/
(SARRS7 RsPAAr a
rvncrs ;/-/ L-.zG /T��f t (Z,elet
DESCRIPTION OF WORK: New k Addition
Size of Lot i.."�. 'S •k 43/
Remodel
Moving Bld . Zo e— Fire one
Sewage System Al P$.LCCCI onst.+1taaC4.
�Fr., Conc., Br.,
Stories _Dimensions �� X28'
Rooms (^ Baths Basement
Full, part, non4.1-0—
.PIS 9 n(•f.f
2.19 a etc.)
�u-/* /O X 23 �t22.X"i- Total Sq. Ft,. Valuation B Dav
/nl 1
Heat. Systeme�� o),('.t,M-. Typ of Roo
Use of Bldg.
T '(.r1 ,V, OA
(� Mti•I`�C�Y
Foundation Const. Chimney 2 Fireplace-- - "leftt"'t
et
J�FPing Ext. Finish
LIXOit!'L
(Kind) �,,�{ (Nurnber
r lr,tts4 q
ry�� /�.-�/-- Int Wall Finish / �1'
ate Car No of Units _ Bedrooms
PLOT PLAN
Draw sketch with dimensions showing: (1) property lines; (2) street or road locations; (3) location of existing and
proposed buildings; (4) distance to property lines and streets; (5) dimensions of buildings; (6) location of sewage sys-
tem and water supply lines. �--�-1
RTH .
RESIDENTIAL, L COMMERCIAL
2�Svt
SOUTH
I h
as shown
y.cert
ted
Owner or Age
A LAND USE OR STRUCTUR
i ONISH� O PAWL
State License No.
T� i�—FJ o3=2de6
Ind. Ins. Acct. No.
-77
puTvvF/L.E'
R ^ r ED
Plumbing Permit
Heating Permit
Sewage Permit
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
rect and there are no other structures located on this property excel
t-�`-
•
—AO —7lp
Date
ERMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
DO NOT WRITE BELOW THIS LINE
Your street address will be ,V (o pay .kLaat•21-Le-!-(i ./c)2(/ The zone ieC(�qu.CUlli/ < <411-;
Sewage Permit Number Issued C Building Permit II/214 Receipt ( fJO , Issued
Remarks
Form 523 Bldg. Code
•
STATE nitrnwA lb. wnere toe structure aouts 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_oerformed 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.
APPLICANT FILL IN BELOW THIS LINE ( ,� ('_ /tl�, �9CIav
4 Lit,
n'A Phone :1.4/
Name of Owner / `.i s♦I ��_'�L� •'iL%� Address B�='F7 �!'-� =��'iS2' —:,3-:!-219
Architect Address Phone
Engineer, ,( Address Phone
Contractor 4ti/Liv: i.e., Address di
Phone
Legal Description of Property (Give complete description from deed, tax receipt, etc.),14/?'
.-t:sty'Vi - /fc)`�
Lei r2
f.ARr 137% RAr 4/ ir"24C S cetce.41
DESCRIPTION OF WORK: New )( Addition
Size of Lot LI -c l3
Remodel
Stories p, Dimensions "AC' :l,Y "i' /cl
Rooms L• Baths 02 Basement ;fit/ l� (` Foundation Const iF
(Full//, --pant, none),,�f t/�
Use of Bldg. i'�.l,-l..1 .•W. Ar0.4.1,('I'J-J 'd. Atit.-Lct l (s(
Heat. System 1 .gCt -•`F! Typ of Roofing 5 1--G,;:.c2-R=�-- Ext
Moving Bldd�pg. Zone A
Sewage System tc r P4Z<2
:21
.(•L /• Total Sq. Ft "� ----7
l'ifL.ts'= Chimney :7
') (Kind
Finish' i_ .'- Lr ✓.[ Int Wall Fin
/fat
'L No of Units
Fire Zone y;
Const: -J'L= .4 t C C
IFr., Conc., Br., etc.) Jy=
Valuation SI—Us°
Fireplace—' - /%y%C%tt'
i\ (Nu ber g
ish ,L`5,:r '.f(4
Bedrooms 11
PLOT PLAN
Draw sketch with dimension ,S ow ng: (1) property lines; (2) street or road locations; (3) location of existing and
proposed buildings; (4) di
tem and water supply ligE's
roperty lines and streets; (5) dimensions of buildings; (6) location of sewage sys-
H RESIDENTIAL.L COMMERCIAL
�__-- 2.23z!
/1
I
I hre y certi
as shown,
State License No.
-7`r-/&-rj i,.3=1dC{i
Ind. Ins. Acct. No.
'z'r O1✓ trf <r
REQUIRED
Plumbing Permit
Heating Permit
Sewage Permit
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
y ijformatUon rted is oriect and there are no other structures located on this property except
Owner or Agen'
SPE
Date
STRUCTUR
A LAND USE OR Ei RMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS HOT A P MIT.
614,1 .711a10.- 44.1may/ DO NOT WRITE BELOW THIS LINE
Your street address w111 be .Z' /, 0. "1 L fi ,L'aj et t1'. i! : 41,C( The zone isst'2 7 1 ,;; J../-;C.Li21 j3
Sewage Permit Number Issued f Building Permit /eL,,27y, Receipt n filo Issued
Remarks -
SPOKANE COUNTY
PROJECT APPLICATION
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
Project Description: -
TYPE OF APPLICATION
❑ Building Permit
0 Change in Use
❑ Grading
0 Manufactured Home Permit
0 Relocation
0 Sign
0 Tenant (New/Change)
0 Othe 99,6,,e, a 7,j Pero
SPECIFIC SITE INFORMATION
Street Address: g e 03 / ! Rt a,y r , n /;!!/l a Ll,, j A 9 to
,%�
Assessor's Tax Parcel Number(s): / V /
Legal Description:
..%kE:..._
" 0
e
...v...
... 3- < •J --'
artment.Use.On
N'Pu� P.-d[..:.....-.Y^i:.^:..e•. WG.:'�ri.'...4. -.tr: ..�:�..:i.:'.:...r:: f_:5�•; :::.:a: "n .. .. :'-0.... �.. ... �r
--OAa'C.:. i.L.--... '-i- t4%iiCT:^S:^::...sit .6 ..'-- S:.at»SEb�L:•�Y•...............:J:SL:: _t L::::�, .:-. ..G :f .: ._'-"' .:.
.wi .-... .. ; .. ...'•.Fadi'..:' i )r ..... .....- -�:
---
;Pa :'::..iYa 3�a,-ar..�:.x,.:r...' .r ::i•a::. �'-T§:_ : - :e:r;•:r:;v, :':,:ay :?:.; .: ,.. ::.. :_ - _ .s'% :r t _; r;: .. _., -- - _
ater District/Puive oi::-, �`-:i"�;`
:.EEsn..a...... ::. ::. .Y '. ..... ,..vs
::-• ....
..: e,91: r. .,.. ...^i
Sewer Districi/Puiveyor'i-. ii liar-tr' f;ii:.a:
Jiif;iwe??a iiS .':-::�•:.....:......u;;:::kiii33:
, .. ,..
•:.i '''i du"o-,
;Road aidthi; '; `;; iii -r .E:,'
i':{.: "
:4f, J'
i; Setbacks:::-"'--
i.i', ]!`.
: Prun[ ...Re57;,,..
e:M1
- -
:ft' : .. ,R,ghii; e ,. •..: .� ”.
: Seh.00lDne:,., ....Firc'Diiii
icY.'.'' ,..: .„. :ii
r., .
Zoning .: �
OWNER/APPLICANT INFORMATION
El Indicate who should be contacted regarding this project
❑�—Oy�wner �j % Phone: yG?%'—/9 Zj6//
L7 -C// el Fax' / 09-/'?Y'A
❑AAp7plicant-
/70h.•Y/f/ctAa/r—P:
Phone- Q3 P-9 -/ 4'cy
Fax:
ne F-iCIn
Mailing Address '
Mailing Address l/// //
Dimensions
City, State, Zip
e) / yr- (6,
7Po�
City, State, Zip
/%nom GrJi7
Occupancy group
Construction type
❑ /ntractor
Phone
Fax
Architect/Engineer
Heat source (electric, gas, etc )
Phone
Fax
Mailing address
Mailing address
City, State Zip
City, State Zip
WA State Contractor license M
Contact name
PROJECT INFORMATION
tillIrig`In.o"rmauori
Budding height to peak
# of stones
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2"'1 floor sq. ft.
Finished basement sq ft
Occupancy group
Construction type
Garage sq. ft
Deck sq. ft.
Cost of project
Heat source (electric, gas, etc )
IVlanufactured:I Iome . o° ','".; :•` •:':i`
81 �-n
Width:
Length:
What is the square footage of the sign
face?
How high is the sign?
Year:
Make:
N of signs
Area of existing signs
Relocation -; • ',"
Fire Sa et.
Non-Resideritia1 Ener Code Com llance?
gy p _
Previous address
Fire Sprinkler
Tent
Paint booth Fire Alarm
Fireworks display
_
_
Proposed use
Value
Spec--;,
1
specfio l:, , , -::-. : €
Non-Resideritia1 Ener Code Com llance?
gy p _
What is the current use of this property?
l'
Firm Name
Phone
Plans Examiner
Phone
Inspectors:
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
(/%) O Yes 0 No
Address
Inspector
Phone
O Concrete
0 Welding 0 Bolting 0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No
If yes, identify on site plan
What is the current property size?
(square feet or acres) '
Is any part of the property within 250 feet of a shoreline?
If yes, identify on site plan 0 Yes 0 No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes 0 No
Will the site be served by a septic system? 0 Yes 0 No
Is any part of the property within a 100 yr flood plain?
If yes, identify on site plan
0 Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located on the property?
If yes, identify on the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the
property?
If yes, identify on sate plan 0 Yes 0 No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
(/%) O Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
DEPARTMENT USE ONLY
tlie;proper[y, tm g'destgnated; Stoimwater;Coiitrol!i
Isthe;property;,mstde "i6e `ASA?^:
Is,ihei 'rope ty; tnsi le' [he PSSA? " .;
P
ee
Date Receive
l 3-ao
Is'p l lic wateraGa 1a61e ios'fhe-`site?;'
p' p y ocate wi[hitiE:1000 feet -of a Natural
Isa e ro ert ,
source.'