1987, 07-02 Permit App: 87002016 ResidenceSPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY
NORTH 811 JEFFERSON
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit and state that the information contained in it and submitted by me or my agent to compile said permit is true and correct. In
addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE provisions included herein and agree to comply with same. All provisions of laws and
ordinances governing this type of work will be complied with whether specified herein or not. I understand that the issuance of this permit and any subsequent inspection
approvals or Certificates of Occupancy shall not be construed to give • -•rity to violate or cancel the provisions of any state or local law regulating construction, or as a
warranty of conformance w'y the provisions of any stat- o local law. reg :ting construction.
SIGNATURE OF
OWNER OR AGENT TE
APPLICATION
PROJECT NUMBER= 87002016
DATE= 07/02/87 PAGE= 01
********************************* APPLICATION ******************************
SITE STREET= 17611 E MONTGOMERY AVE PARCELO = 07552-0411
ADDRESS= GREENACRES WA 99016
PERMIT USE= RESIDENCE W/ GARAGE
F''L-AT4= 003987 PLAT NAME= SP -:317
BLOCK= LOT= ® ZONE= AGR:C DISTO= G
AREA= 00000000 F/A== F WIDTH= 93 DEPTH= 145 R/W:= 50
OF BI. -DGS= 1 0 DWELLINGS= i
OWNER= SIMANTON, JAMES N
STREET= 218 N FOX RD
ADDRESS= SPOKANE WA 99206
CONTACT NAME= OWNER
PHONE= 509 926 0410
PHONE NUMBER= 509--926•-0410
BUILDING SETBACKS: FRONT= 50 LEFT= 20 RIGHT= 40 REAR= 80
******************************
DEPARTMENT NAME
BUILDING & SAFETY
REVIEW INFORMATION **************************
DATE
:CN/OUT INITIALS
REVIEW COMMENTS
PLAN REVIEW REQUIRED
COUNTY ENGINE:ER NEW_CPUNTY ROAD APPRO
ENVIRONMENTAL_
870702 GGM
870702 GGM
TONAL WASTE W ' 8707/'2
******************************* BUILDING PERMIT ****************************
CONTRACTOR= JAMES N SIMANTON
STRE:ET= 218 N FOX RD
ADDRESS= SPOKANE WA 99206
NEW= X
DWELL UNITS=
BL..DG W X D =
REQ PARKING=
1
PHONE= 509 926 0410
REMODEL= ADDITION= CHANGE IJSE=
OCCUP. LD= BLDG HGT= STORIES=
X SG FT= 2283
;HANDICAP= SEWER= N HYDRANT= N
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(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)
SHADED AREAS ARE FOR DEPARTMENTAL USE
Owner's Name LAST FIRST MI
5 i v)- - 0 ' ��. N rite's
Project Address (Street Name & Number) Zip
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Applicant
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Address
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City
State
Zip
Phonej ( /) C7,6 .'--D eil ID
Business Phone
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Contractor /Agent
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Address
City
State
Zip
Phone
( )
Contact
License Number (R uired)
Slut./% 22g M 7.
Business Phone
( )
Architect/Engineer
Address
City
State
Zip
Phone
( I
Contact
Business Phone
( )
Lender
Address
City
State
Zip
Phone
Describe Work
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Res.
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Comm.
Subdivision/Plat Name/Short Plat Number
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Assessor Parcel Number /�
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Lot
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Zone
Block
Comp. Plan
Plat Number
177
Census Tract
Pertinent File Numbers
Number of Dwelling Units .
Number of Buildings
Lot Size (Sq. Ft./Acre)
• e, b '.
Depth
.-'
Frontage
/ zi .
Front Set back
Left Setback
Right Setback j`
4 r
Rear Setback. {
R/W Width
Additional Information ,
I BUILDING INFORMATION
S tuare Footage
r
t)6'(.054— 4
Number of Bedrooms
Building Technician
Date
Group
Type
Show on Site Plan:
Lot Dimensions
Existing Structures
Proposed Improvements
Structure Setbacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Additional Information:
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
Legal Description
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Scale:
Date:
Revisions. Attachments:
J
1
DEPARTMENTAL REVIEW
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
Approved
Cond.
Approval
Hold
Environmental Health Application #
,
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Firs Prevention
N. 811 Jefferson
Other (SEPA/Critical Material/etc.)
t
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
•
*************44********4*******************qtr*-,****%***r****#**4**#******44*****v
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* GENERAL INFORMATICN
*
* PARCEL NUMBEP :
* *
* STREET ACCREcS: *
*
* CITY/STATE/ZIP: *
*
* SUBCIVISIGN:*
* *
* BLOCK:_____ LOT: ZCNE:____ CISIRICT#:_____
* *
* LOT AREA: F/A: hIDTH:DEPTE: R/1i: *
* *
* N CF eLCGS: # CF DWELLINGS: *
*
* OWNER: FF -CNE: — — *
* Y
* MAILING ADDRESS: *
* *
* CITY/STATE/ZIP: *
* *
* CONTACT: FHCNE: — — *
*
* SETEACKS — FRCNT LEFT RIGHT PEAR__ _ *
* *
*
PERMIT
ERMIT LSE:
SE: *
__________
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4 # * * * * * * * * * T * 4 # # # # * * * * * * 4 4 4 4 # 4 4 4 * * * * * * * * * T * * * * * * * * * * * * * * * * * * * * 4 * * * * * Y * * 4 * * * * T *
* PLUMBING INFCRMATION *
* CONTR LIC#: 4
* *
* CONTRACTCR: PF -CNE: — —
* *
* MAILING ACCRESS:
* *
4**4**####44#4444444*****x*********************************************x******
* MECFANICAL INFORMATION
* CONTR
* *
* CONTRACTOR: PF -CNE:
* *
* MAILING ADCRESS: *
* *
* ELECTRIC:_ GAS: _ CIL:___ CCAL:_ h000:___ SCLAR:___ FEAT FUNP:_�
*
*
s**********4#*44*44********************************************4*******:#*44,44,
***********************************************************************.**********
MECHANICAL FEES
ITEM DESCRIPTION
PROCESSING FEE
DUCTWORK SYSTEM
wOCCSTCVE/INSERT
GAS WATER HEATER
GAS HTG EQUIP<10C,000>BTU
GAS hTG EQUIP+100,000 BTU
GAS PIPING - # OF UNITS
HEATPUMP 1-100M ETU
HEATPUMP 101-500P BTU
HEATPUMP 501-1,000M BTU
HEATPUMP 1,001-1750M BTU
HEATPUMP +1,750M BTU
REFRIG 1-100M BTU
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
kEFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
AIR CONDITIONER 0-3 HP
AIR CCNDITICNER 3-15 HP
AIR CCNDITICNER 15-3C HP
AIR CCNDITICNER 30-50 HP
AIR CONDI TI-GNER +50 HP _
VENTILATING FANS
EVAPORATIVE CCOLERS
HOODS
CLOTHES DRYER
RANGE
GAS LOG
UNLISTED GAS APPLIANCE
AIR HANDLER 1-10000 CFM
AIR HANDLER 10000+ CFM
Mt,MBER CF
YES OR, NG
PLUMBING FEES-
ITEM
EES
ITEM DESCRIPTION
PROCESSING FEE
TOILETS
SINKS
SHOWERS
BATH TUBS
KITCHEN SINKS
DISH WASHERS
GARBAGE DISPCSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIC WATER HEATERS
FLOOR DRAINS
FLOCR SINKS
BAR SINKS
ROOF CRAINS
LAWN SPRINKLER
SEWAGE EJECTCR
WATER SOFTENER
URNAL
DRINKING FOUNTIAN
NUMBER OF
YES OR NC
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