1986, 08-26 Permit App: 00013505 Garage(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
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Project Numbers -•
•�==KK-.13565;
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Owner', Name LAST FIRST MI
to RYt.t d Ake et D,
Project Address (Street Name & Number)
Zip
/a1 11 o fC. C44 c e '
Applicant
$Avec D. atilt&
Address
Ittle i• -CA4e e
City
SPait4..4
State
4.srA
Zip
,t2eG
Phone
509 (9lC Goy,
Business Phone
1 )
Contractor/Agent
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Address
City
State
Zip
Phone
( )
Contact
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License Number (Requ
red)
Business Phone
1 )
Architect/Engineer
Address
City
State
Zip
Phone
I )
Contact
Business Phone
( )
Lender
Address
City
State
I Zip
Phone
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DEPARTMENTAL REVIEW
N
Ea-
/
Approved`
_pond. Hold
ADProval
Environmental Health Application I C/ v ..tea. ' i -
'1�
(• �f41
W. 1101 College t�•i ,' 1 :—^: -
.;3k,..x`,,...f ' '",`
/'�''�JRoom
A 4
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4:779
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WY
024 .;-�_
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Planning/Zoning - �......
N.721 Jefferson 'I
„
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
•
Plan Review/Fire Prevention
N. 811 Jefferson -- - -
•
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
I certify that I have examined this application and state that the Information contained in it and submitted
by me or my agent to compile said application Is true and correct.
Signature
Date R C Aft' PC
A
Form Approved
5 FEDERAL HOUSING ADMINISTRATION Budgetu
:'` '/ HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
eau No. 63-8296.8
r" PART I.—TO BE COMPLETED BY FHA
INSURING OFFICE
Spokane, Washington
MORTGAGEE •
J. L. Cooper & Co.
SERIAL NO.
562-003042-2G3
MORTGAGOR OR SPONSOR
Jack D. & Lois Teigen
PROPERTY ADDRESS
/2//0
E. 42 Q&
Grace Ave.,
Spokane, Washington
SUBDIVISION NAME
BLOCK NO. I
9
LOT NO.
1
TOTAL NUMBER:
1r�
Can
LIVING UNITS
BEDROOMS
BATHS
BASEMENT
❑(I New instainsinstallation$[allao
Pr �1
attic or
additional
other area be made Into
bedrooms?
1
J
2
)( Yes No
Yes
(If Yes, haw many')
E. iNo
WATER SUPPLY BY:
Public system❑
I
I�
SYSTEM DESIGNED FOR
Community system
�
u
I Individual
NO. or ADAMS.
GARIAGE DISPOSAL
SEWAGE
DISPOSAL BY:
Public system Community system fl
Individual
3
lyes
jJ
No
PART 1I.—TO BE COMPLETED BY'HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH '
,
I
1
1
1
1
1
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tit
.
It
is the opinion of the
is ❑ is not satisfacto
LI Sta e
y as
❑ County fl Local Department of Health that thi ndivi ual wa er-ssappy sy tem
a domestic water supply for the subject property. lil t[I''\U [In BY
It Is the opinion of the ❑ State X County Local Department of Health that this indivu LL isc,w` d' l al ys-
tem with proper maintenance: ictn
nCan be expected to function satisfactorily, and Cannot be expecte to,functipq• satjsfactoiily
tit': b}c4 Jt ll
is not likely to create an insanitarylncondition -..__
DATE
March 27, 1963
SIGNATURE kl / �j /j ,/� TITLE „li /A�uIiYl6T-/
9 _ - Supervising Sanitarian
NOTE: The health authority should complete the appropriate opinion statement above and affix date, signature and title In the
spaces provided.
Use of the above grid for Health Department Inspector's sketch as well as use of the back of this form Is at the option of the
health authority.
PART III.—FOR USE OF FHA OFFICE
TO THC CHIEF UNDERWRITER:
I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that 'the
Individual water -supply system be considered [J Acceptable [] Not Acceptable
Sewage disposal be considered fl Acceptable • Not Acceptable.
DATE N.
SIGNATURE
❑ CHIEF ARCHITECT
❑ DEPUTY FOR CHIEF ARCHITECT
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2373
Re. July 1958
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