1976, 10-04 Permit App: L5769 MH0
County of Spokane, Washington
BUILDING CODES DEPARTMENT, N. 811 JEFFERSON, SPOKANE, WASHINGTON 99201
APPLICATION FOR LAND USE OR STRUCTURE PERMIT e�.a
GENERAL REQUIREMENTS PERMIT FEE._,�P_,"S�_ ........
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 mast conform with the
Spokane County Building Code and Zoning Ordinance. Construction is subject to inspection.
NATER. 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.
`�t APPLICANT FILL IN BELOW THIS LINE
Name of OwnerI�( Address Phone
Architect Address Phone
Address - 41 Phone
Engineer % Address 5' `7— Phone - 6_)l U
Contractor
Legal Des ption of Property (G�ye complete description from deed, tax receipt,
DESCRIPTION OF WORK: New _ Addition Remodel Moving Bldg. Zone Fire 7 -
Sewage of Lot �.rl �' Sewage System Const.
/ a Fr., Con etc.),
Stories 1 -Dimensions ,&— /4/ 'y i�r� Total Sq. Ft. Lp� Valuation 4 !2420
/" Rooms __ _ Baths Basement Foundation Const.. 93.&tr_ Chimney Fireplace +d --
�" Full, part, none) ,ry (Kin) (Nu er
Heat. System Type of Roofing _ le-td� Ext. Finish ?PYA Int. Wall Finish
�. Use of Bldg.No. of Units _Bedrooms
PLOT PLAN
Draw sketch with dimensions showing: (1) property lines; (2) street or road locations;
proposed buildings; (4) distance to property lines and streets; (5) dimensions of buildings;
tem and water su pl lines
P y
t NORTH RESIDENTIAL — COMMERCIAL
(3) location of existing and
(6) location of sewage sys-
State License No.
Ind. Ins. Acct. No.
REQUIRED
Plumbing Permit
Heating Permit
Sewage PQrmit
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
SOUTH
I hereby certify information submitted is correct and there are no other structures located o thi property except
as shown. /
` Owner or Agent Date L
A LAND USE OR STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOT A PERMIT.
DO NOT WRITE BELOW THIS LINE
,
Your street .pddress will be The zone is
Sewage Permit Number Issued Building P mit Y W,Receipt,.� �� Issued
Remarks
Form A?3 Rldl Cnr4o