1977, 04-21 Permit App: M0786 Remodel• •
County of Spokane, Washington
BUILDING CODES DEPARTMENT, N. 811 JEFFERSON, SPOKANE, WASHINGTON 99201
APPLICATION FOR LAND USE OR STRUCTURE PERMIT
GENERAL REQUIREMENTS PERMIT FEE 1,
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 on water 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 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 c%�� v 4'
/
Name of Owner i 7 J S/94-4: d � �"7 Address i /C -j 0 / A/A k A ✓ Z Phone ,
Architect Address Phone
Engineer
Contractor /'(i i .-
Legal Description of Pro
304,
DESCRIPTION OF WORK: New 4ddition Remodel Moving
6LC14=-4-1
y
Address
7 / L / c i A.7 Address ' "'.' ._�---"
(Give complete description from deed, tax receipt, etc. Parcel
Phone
Phone
Size of Lot
t < ^� %_,
Stories I Dimensions .�<%' /`- � L -L 11{�i',4--6-e-'('
Rooms ! Baths t Basement' 4- Foundation Const i-rP-1 Chimney J 4r'z 7 Fireplace / Mf'/ a' /
(Full, part, none . (Kind) (Number
Heat. System c - / Type of Roofin•: b=f---r'r ' c"" Ext. Finish )C_t5 fir"' j Int. Wall Finish '�_X''rT'
Use of Bldg. �. C ' No. of Units Bedrooms
�'
�
�^t rc `�-n 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.
BI g. Zone Fire Zon
21,7'
Sewage
Sewage System 't,s onst.
(Fr., Conc., Br., etc.),
Total Sq. Ft / Valuation
m
I hereb
as shown.4 -itti „I, . /�
OwnerArAgent Date
A LAND USE OR STRUCTURE PERJIAIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOT A PERMIT.
SOUTH
State License No.
Ind. Ins. Acct. No.
RESIDENTIAL - COMMERCIAL
REQUIRED
Plumbing Permit
Heating Permit
Sewage Permit
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
ertif4 inforgation submitted is correct and there are no other structures located on this property except
DO NOT WRITE BELOW THIS LINE
Your street address will be / G �' " ('�� A/it i c /77 -"rt t
The zone is
Sewage Permit Number Issued Building Permi> ) , ' ..Receipt __LIssued
Remarks Ili
Form 523 Bldg. Code
All1N''UTON S'AT'E FIR E MARSAL
INSURANCE BUILDING—OLYMPIA, WA 98504
FIRE & LIFE SAFETY INSPECTION
Property Inspected /1 l �� S / a /
/ /a3 o
Inspected By Al full C. 13.6 Li
Reinspection Date / 47 - 7
Item Description, Locati
1
Date
et ll Ct i -Q
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cf.
• orrection Required Date
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SPOKANE COUNTY
BUILDING CODES DEPT.
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The described deficiencies have been explained to me and I agree
to correct by the dates indicted.
Signed ,
9/15S
Ad03 S‘HO.L33dSNI