1984, 10-19 Permit App: 00002962 Storage Bldg BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (((llast) / (first)(s (m) Department Use Only
5 E 1 c Q c_F->./a+) IRIS. Comm
2 Project Address(not Mailing Address)or Name J Space Zip
I NC Road lar fl
3 CltylCom nity 1 �((J_ Stag ' Sy ivls �Plat Name 5 ' I, 14D'
4 Assessor Par No. J Lot Block
i 4tcli —.1+
1+ —C [ 3
2 * * * DEPARTMENT USE ONLY * * *
5 Sic Code tone Act.I Zone Project No.
Pr S
6 Dwell I No.of Buildings Sq.Ft./Acre Depth 1 Frontage 1
1 2- lad I2-.1
7 SeBack-Front ��� I(L)S-1 (R)S-2 1 'Rear i Census Tract Module No. ,Initials�N � f
* 16 Architect Firm Name Street Address *
Zip City State Phone
( )
Contact Person Phone If different than above
( )
ntractor Firm Name Street Acity8
etic*„
\-da. ,J v6:-.y.vo L_f CY 14--E
Zip _ qty State ^ Phone
CAG U/.Z 46,t1cli1�'� l 59 1 - -
Con)FPerson License No.
Phone if different than above
i2 E- �^r 1.Cr PP - :5`./� 1.7_, ( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone`1>4 C _(^ - 1
2l,ti
12 Review Required Plan Check(YIN) Other(YIN) 1 SEPA Exempt(YIN) Date
15 Type Work Bldg E MH y New ❑ Replace ❑ Other
0 Fire 0 Demo 0 Add/Alter 0 Move
14 Describe Work
)(1(1-1) )C1 C) — OD ' ---\tr
10 Applicant Name Street Address
11 Zip City State Phone
( )
* *
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
DEPARTMENT APPROVALS
This is nota Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.)
❑ Fast Track
❑ Early Start Release
ReleaseJ�( w/cond 1 Hold 2
Er Environmental Health ❑ Commercial; ❑ Residential ri f i ♦4
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition j/ �� IG' / �� ,�i.,_
Room 200 �' Additional structure; = ��-���/// cJ'Q�`,�
APPLICATION# (1-7) •
l� ��
Conditions/Comments: C C
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
❑ Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; I I
. N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
•
❑ Plan Exam
Fire Prey.
Conditions/Comments:
c
N
C
❑ Project Representative
CD Telephone
Agencies Performing Special Inspection:
cn
Y o 1•
U
f0
7t-
Ft
F`- E 2
in o
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3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
APPLICATION AND PERMIT FOR ON-SITE SEWAGE SYSTEM .1 f
SPOKANE COUNTY HEALTH DISTRICT 1. APPLICATION NO, 8 t
ENVIRONMENTAL HEALTH DIVISION 2. CENSUS TRACT
WEST 1101 COLLEGE AVENUE to-/5-- `
SPOKANE, WASHINGTON 99201 (509) 456-6040 DATE OF APPLICATION
3. SITE ADDRESS OR
OR LEGAL D,EtSCitIPT_ION OF PROPERTY: 4. PROPERTY WITHIN: _. ASA
/ tom' a �A,3A k l t 4 GSSA
5. LEG, OWNER OF PROPERTY: ADDRESS:
, .E-*/L - i 1 9., 7"eits,c5/
16. PROPOSED VSE OF PROiERTY: SINGLE-FAMILY RESIDENCE - NUMBER OF BEDROOMS• 3
(COMPLETE ALL THAT APPLY) TYPE OF STRUCTURE:❑MOBILE HOME t]RANCHER ❑SPLIT ENTRY ❑MULTI-
❑MULTI-FAMILY COMPLEX: NO.UNITS NO.BEDROOMS/UNIT LEVEL
❑COMMERCIAL/INDUSTRIAL (DESCRIBE)
7. PROJECTED FLOW RATE (IN GALLONS PER DAY)
IS THIS PROPERTY LOCATED WITHIN A PUBLIC SEWER UTILITY DISTRICT OR MANAGEMENT SYSTEM? OYES ONO
IF YES, NAME OF DISTRICT/SYSTEM:
r
8. WHAT WILL BE INSTALLED OR ALTERED? ■ISEPTIC TANK ' '' 0%Or' ALLONS NO,TANKS_ ARE TESTHOLES
SRAINFIELD "� LINEAL FEET READXI FOR INSPEC..
TION!❑YES ONO
10. IF REPLACEMENT, WHAT IS REASON ❑DRY WELL GALLONS
FOR R[:PLACEyzNT? 9,❑DOUBLE PLUMBING: ❑REQUIRED ❑RECOMMENDED TIONS STHOL VENSTOUC
0 r 1 CO I` , + ❑OTHER (SPECIFY): f n APPLICANT 0
11.WH I THE SOURCE OF WATER 'OR THIS PROPERTY? ❑PUBLIC WATER SYSTEM; NAME
❑SHARED WATER SYSTEM
❑PRIVATE WELL ❑SPRING ❑LAKE [JOINER:
THIS APPLICATION AND PERMIT APPROVAL IS CONTINGENT UPON MEETING REQUIREMENTS SET FORTH IN THE SPOKANE
COUNTY HEALTH DISTRICT RULES AND REGULATIONS FOR ON-SITE SEWAGE SYSTEMS. APPROVAL IS BASED ON THE
ACCURACY OF THE INFORMATION SUPPLIED BY THE APPLICANT. IF YOU ARE DISSATISFIED WITH THE DECISION
OF THE HEALTH DISTRICT, YOU MAY APPEAL TO THE HEALTH OFFICER WITHIN TEN (10) DAYS OF DENIAL OF THIS
APPLICATION (SEE APPEAL PROCEDURE).
CO PHONE
*,'4;72,_00 .- /4
SIGNATURE 0OWNER OR AUTHORIZED REPRESENTATIVE:2-441-46.-
PHONE: DATE:
t'APC PERMIT {LAID. CORR-PONDENCE TO://4/in I ' ('„ ) te,.,tJ 71,7)/ c"`.
TESTHOLE INSP ,LIED IN ON (DATE) FEES PAID: sSEstRip, f TF,.--'4.. G . k
FILL/OTHER INSP. CALLED IN ON(DATE) APPLICATION / 9 . f (
FINAL INSP. CALLED'IN ON (DATE) PERMITecif
EXPERIMENTAL
RELEASE TO BUILDING CODES DEPT.(DATE) REINSPECTION
RENEWAL,
TESTHOLE APPROVAL: (SIGNATURE AND DATE) OTHER EH PROGRAM APPROVAL: (SIGN.AND DATE)
OTHER AGENCY APP'• 'L:(NANE OF AGENCY, PERSON APPROVING, AND,DATE)
/�
APPLI ,-,_„-,
FATAQ ' �.'. . Y SAND DATE) �( P ON EXPIRES: DAT PERMIT I EXPIRES:
I.
INSTALLER:
HONE: INSTALLER'S SIGN: 12.FINAL INSTALLATION APPROVED:
SIGNATURE AND DATE':
REMARKS: (ADDITIONAL REMARKS AND AS-BUILT PLAN ARE TO BE PLACED ON THE BACK OF THIS FORM. PROPOSED PLOT PLAN IS TO
ACCOMPANY THIS APPLICATION, ALONG WITH ANY OTHER PERTINENT INFORMATION, SUCH AS LEGAL DESCRIPTION OF PROPERTY.)
o
SCHD-EHD-002 (REVISED 11/83)
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