1971, 10-12 Permit App: J0985 MH41001 47: 1
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County of Spokane. Washington 1 v----
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 most conform with the
Spokane County Building Code and Zoning Ordinance. Construction 1s subject to inspection.
WATER. Water supply must be approved by the County and State Health Departments. Where work on water connect tons 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
Name of Owner
ddress Sr G 2 y ryJ�!-
Phone G!/A1 ip_6:1 3 9.
Architect Phone Engineer Phone
Contractor Address Phone
Legal eseription of Property (Give complete description
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DESCRIPTION OF WORK: New Addition
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Size of Lot / 71-0 icZY—
Constr y/ -j in Dimensions /07 )C ' 0
(Frame, concrete, brick, etc.)
Rooms Baths / Basement Foundation Const
(Full, part, none)
Type of Roofing Ext Finish
tax recei t, etc.)
4 y� C// 07-)
Remodel Moving
Sewage System
Total Sq. Ft.
Heat. System
Use of Bldg.
Fire Zone 3
Stories /, g d
Valuation f�$( (/D
Fireplace
(Kind) (Number)
Int. Wall Finish
No. of Units Bedrooms
Private Detalehed
���� Chimney
Garage or Carport Att
t -6J £ . /LAL. a O
PLOT PLAN
Draw sketch with dimensions showing: (1) property lines; (2) street or road Iodations; (3) location of existing and
oposed buildings; (4) distance to property lines and streets; (5) dimensions of buildings; (6) location of sewage sys
tem and water supply lines.
S
SOUTH
I hereby certify information submitted is,correct and there are no other structures located on this property except
as shown.
State License No.
Ind. Ins. Acct. No.
REQUIRED
Plumbing Permit
m Heating Permit
MSewage Permit
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
14t' B
Owner or Agent t/ Date
A LAND USE OR STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS 1S NOT A PERMIT.
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Your street address will be
Sewage Permit Number Issued
Remar
DO NOT WRIT BELOW THIS LINE
n
Bu11di'j ermit
e zone is
Receipt O 5 3( asued
Form 523 Bldg. Code