1983, 05-24 Permit: 83A-4412 Residence PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER.
e liX15 ,SPOKANE COUNTY - DEPARTMENT OF BUILDING &SAFETY ,1& -4412,
(/ ' NORTH 811 JEFFERSON /SPOKANE,WASHINGTON 99260/(509)456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET- iADDRESS
( 2 1Q PARCEL NO. ..--)i,_-- E
LOT BLOCK SUBDIVISION r< LEGAL DESCRIPTION:
2. �� . J 2O .
OWNER L i, PHONE PHONE
3. .. .e_'' ' 1.1,', " , %.� :.a 3Z '. Q60.
MAI ING •DDRES1 ZIPActual Set:- ks in Feet to:
N t 9,-2.„-,r5 North 'South ) East 5' I West
CONTRACTOR LICENSE EXPIRES PHONE Size of Parcel& neClassiftion
w 1��%' i icaResidential❑
4. I� �s'{„�I ?k l 5 p. < '3� ) - Commercial❑
ADDRESS ZIP Typetignst. Occupancy Sprinklered t L x .: r, V (. v
IN 2-, ❑Yes ❑No ❑Req'd.
DESIGNER PHONE New Co st.Valuation Remodeled Valuation Total Bldg.Floor Area ' (' C V 0
* G 0. C
5. ADDRESS ZIP Main F oor_ ?6 4--
r Floors Garage/Storage Greenhouse
ICFJ - ?-+ l_ 1
CHANGE OF USE FROM TO Cover Deck Uncv.Deck Fin.Basement Unfin.Basement
_ , ,\
,- No.Baths No.Floors No.Fin.Rooms No.Dwenings L 7
TYPEEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7• OF '�,/ ❑ OTHER
WORK BLD. 0 PLMB. 0 MECH. ❑ M.H. ❑ POOL Certlfi.of Exempt. Required Yes❑ No❑ Number
or Variance Received Yes No❑
DESCRI RE WORK Shorelines/Flood Hazard Plans Require
8. K ;,,i Iote-Nr , YesE Not Applic.❑ Received
VALUATION SOURCE GAS ELECTRIC PUB
ER / SEWAGE/TIOwnership FEES COLLECTED
9' UTILITIES PRIVATE❑ SEWER❑ Public❑Privetec
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
reverse side,and know the same to be true and correct. All provisions of laws and ordinances governing this type of Building
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction.SEE REVERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
SIGNATURE OF -/ )7 APPLICATION �`l.Jo /O
OWNER OR AGENT /�/�(( DATE V `` G� r tT Mech.
SPECIAL APPROVALS PECIAL CONDITIONS: EE EVERSE SIDE FOR NOTICE)
PRELIM. ALL�®DATE Plan Check
Env.Health � 3 SEPA
5
Planning "
Modular/
MFG.Home
Fire
Prevent. O.
O
Engineer pL%7, • Other(Specify) V
0 J
Utilities .30
TOTAL $
SEPA
Plans ,7 PERMIT IS NONTRANSFERABLE WHEN MACHINE VALIDATED IN THIS SPACE,
Exam.ln4 /, THIS BECOMESAPERMIT.
J.
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
IN 180 DAYS 11 �j .. o o f
`� DATE ISSUED PERMIT No. l'2 z * 3 6. O TOTAL
L
�. Z 2
Pio, CL
C '"SII HEALTH DIO-tRICT ' . APPLICATION NO. 8J— 7�
Ei IMENTAL HEALTH D VISION
` /Jl 2.CENSUS TRACT / ' r O J
:ST 1101 COLLEGE AV UE fit/
4
`KANE, WASH IhSTON yy2 _: _ 6,Q ��
sr' D �F AR(;L I CAT[ON _ _
ISITE t: • ORP./
•CRIPTI iti 'ROPERTY' -2✓ PERTY WITHIN [ A
. rtf0t- /... . l ' SA
r
. l .044F• — .E ADDRESS:
. t.! lo, , lrJ C P3� �3
.PROPOSED USE OF PRO': SINGLE-FAMILY RESIDENCE =NUMBER OF BEDROOMS_
(COMPLETE ALL THAT A- LY) /_Q
TYPE OF STRUCTURE: 'MOBILE HOME O RANCHER ❑SPLIT ENTRY O MULTI 0 [l
L1=VEL' q� .;`3
❑ML:L?i-FAMILY COMPLEX: NO,I�IITS PJO.BEDROOMS/UNIT �<
❑COM•1ERCIAL./INDUSTRIAL (DESCRIBE) ��(%-
7.PROJECTED FLOW RATE (IN GALLONS PER DAY)
IS THIS PROPERTY LOCATED WITHIN A PUBLIC SEWER UTILITY DISTRICT OR MANAGEMENT SYSTEM?A YES ❑NO
IF YES, NAME OF DISTRICT/SYSTEM:
BWHAT WILL BE INSTAL I Fp OR ALTERED EpTI TANK .SALLONS NO. TANKS Are-testholes read for
(CHECK ALL THAT APPLY) IDDRAINFIELD , ( LINEAL FEET inspection?Dyes no
O DRY WELL GALLONS
IOIF REPLACEMENT, WHAT IS REASON Testhole instructions
FOR REPLACEMENT: 9.D DOUBLEPLUMBING: O REQUIRED ❑RECONr1ENDED
given to applicant ,x
OOTHER(SPECI FY): J
.WHATIS THE SOURCE OF WATER FOR THIS.PROPERTY'1D•UBLIC SYSTEM; NAME (L)(f p
SHARED WATER SYSTEM
LJ PRIVATE WELL O SPRING O LAKE
POTHER (SPECIFY):
THIS APPLICATION AND PERMIT APPROVAL IS CONTINGENT UPON MEETING REOUIREPENTS SET FORTH IN THE SPOKANE COLI Y HEALTH
DISTRICT RULES AND REGULATIONS FOR ON-SITE SEWAGE SYSTEMS. APPROVAL IS BASED ON THE ACCURACY OF THE INFORMATION
SUPPLIED BY THE APPLICANT,
CONTACT PERSON: PRONE S
\ .4
11,144kATURE OF OWNE: T •' . • REPRESENTATIVE: ^ PHONEr DATE:
1
I T AND COR DEI, ` TO: 1-7-4 ;::::2i
FEES. NO.
'AID: A1T,PDjO
TE REG. PIBY
TESTHOLE INSP.CALLED IN ON(DATE) 0 ,_
FILL/OTHER INSP,CALLED IN ON(E' TE� APPLIE"1ON ,233/
INAL INSPECTION CALLED IN ON( ATE) __ PERMIT D, C 4:;ia- " a
REINSPECTION
RELEASE TO BUILDING CODES DEPT A DATE) ( /` _ RENEWAL,
TESTHOLE APPROVAL: .� •TURF R�' �• '�' OTHER EH PROGRAM APPROVAL: (SIGN•F. DATE)
1 ���, s=a3�'3
OTHER AGENCY APPRO T: OF A �•'lw'PERSON APPROVING, AND DATE
APPLICATION APPROV• at . ``i ll'. DATE) E p.it DATE PERMIT ISSUED: EXPIRES'
INSTALLER: +PHONE.411k ,•'j/ ` / � INSTALLER'SSIGNATURE: 12.FINAL /�INSTA���ON (W S �, ��
(SIGNATURE AND DATE) I� // 7va73
REMARKS: (ADDITIONAL REMARKS AND AS-BUILT PLAN ON BACK OF THIS FORM, PROPOSED PLOT PLAN IS T
ACCOMPANY THIS APPLICATION.) .
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