2001, 10-29 Permit: 01008968 C of O+,J
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SPOKANE COUNTY
DIVISION OF BUILDING AND CODE ENFORCEMENT
Building Address: 1�rct raSL 1GLn AVei211e
Legal Description: Parcel No. 45223.4722
Owner: Angel Lee Harris Address: 12721 E. 12th, Spokane, WA 99216
Occupancy Group: Lc c Land Use:
Construction Type: Occupant Load:
Occupied As: AdultFan4ly Cir+Q , lie
Additional Information: ApQroved €or . 3, 9r.'ound floats its r for 2 tenants with Class II
.. ?old .Glamis. Ill . Pacua:tl9o. it ty. and .4. tete .v th.V1a .1.8vamatx9o. capability.
This Certificate is issued pursuant to Section 109 of the Uniform Building Code and is to indicate the above
described structure is approved for occupancy.
Building Official's Signature
THIS CERTIFICATE MUST BE PERMANENTLY MAINTAINED IN THE BUILDING OR STRUCTURE REFERRED TO ABOVE
If the building or structure is used for any occupancy other than that listed, an application for change of use shall first be made to the Division
of Building and Code Enforcement
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Certificate of Occupancy Worksheet Last Update:10/26/01 Updated by J.D.LARSON
Address: 12721 E 12TH AVE Project#: 01008968
Parcel#: 45223.0722 Site#: 37961
Owner. HARRIS,ANGEL LEE Contact: HARRIS,ANGEL LEE (509) 891-2492
Address: 12721 E 12TH AVE Architect:
SPOKANE,WA 99216 Contractor. OWNER ( ) - 0
Occupant:
Permit Use: CHANGE OF USE FROM RESIDENCE TO LICENSED CARE FACILITY
CO Use: a.e6
Occupancy. LC 2 Construction Type: Fire Sprinkler❑ FireAlarm 0
Assembly Area Room# /Location Occupant Load
HS Bolts/ Soil/ Final Report
Special Inspection Agencies: NREC Concrete Masonry Steel Welding Drainage Received By
APPROVED FOR 3 GROUND FLOOR SLEEPING RMS. ❑ ❑ 000 ❑
FOR 2 TENANTS WITH CLASS 11&CLASS 111 EVAC ❑ ❑ 000 0
CAPABILITY AND 4 TENANTS WITH CLASS 1 EVAC ❑ ❑ 000 0
CAPABILITY ❑ ❑ 000 ❑
Inspector: HOWARD,DAN
Coordinator: BURRIS,ROBIN
Date Complete Intials Date Complete Intials
❑ Mechanical ❑ Drainage
❑ 0 Landscaping/Irrigation
❑
0 Parking/Paving
❑ Plumbing 0 Smoking
❑ �br f�I-rJ/ 40/i
❑ Fire Sprinkler REQUIRED APPROVALS
❑ FireAlarm ❑ Fire District FD 01
❑ Fire Hydrants/Lock box ❑ WA DOT
❑ Critical/Hazardous Materials 0 Special Inspection
❑ Grading 0 Record drawings/Stormwater
❑ Demolition 0 Utilities/Liberty Lake Sewer Dist.
❑ Free Standing Signs 0 SRHD:Schools/other
❑ On Building Signs ❑ SRHD:Food Handling
❑ NREC ❑
❑ Special Inspections ❑
Certificate of Occupancy Worksheet Last Update:10/26/01 Updated by.J.D.LARSON
Approved for TEMPORARY CO- Field Inspector. Date: Code Coordinator
Expiration Date: Fee:
Conditions:
Approved for FINAL CO- Field Inspector — Date: / t/ r.
Code Coordinator:
•
Conditions: / /J j�/f �C c ,/�7/--iyr� O
rAd
MAIL CO TO: PHONE: e.f7/
ADDRESS: j o? 7d f �' j„� � `1
•
Date Comments
t
Certificate of Occupancy Worksheet Last Update: 10/26/01 Updated by.J.D.LARSON
Address: 12721 E 12TH AVE Project#: 01008968
Parcel#: 45223.0722 Site#: 37961
Owner: HARRIS,ANGEL LEE Contact: HARRIS,ANGEL LEE (509) 891-2492
Address: 12721 E 12TH AVE Architect:
SPOKANE,WA 99216 Contractor. OWNER ( ) - 0
Occupant:
Permit Use: CHANGE OF USE FROM RESIDENCE TO LICENSED CARE FACILITY
CO Use: l .0Gift' .yle
Occupancy LC 2 Construction Type: Fire Sprinkler❑ FireAlarm❑
Assembly Area Room# /Location Occupant Load
HS Bolts/ Soil/ Final Report
Special Inspection Agencies: NREC Concrete Masonry Steel Welding Drainage Received By
APPROVED FOR 3 GROUND FLOOR SLEEPING RMS. 0 0 0 0 0 0
FOR 2 TENANTS WITH CLASS 11&CLASS 111 EVAC. 0 0 0 0 0 0
CAPABILITY AND 4 TENANTS WITH CLASS 1 EVAC. 0 0 0 0 0 0
CAPABILITY ❑ ❑ 0 0 0 0
Inspector: HOWARD,DAN
Coordinator: BURRIS,ROBIN
Date Complete Intials Date Complete Intials
❑ Mechanical ❑ Drainage
❑ ❑ Landscaping/Irrigation
❑ El Parking/Paving
❑ Plumbing ❑ Smoking
❑ essability
❑ Fire Sprinkler REQUIRED APPROVALS
❑ FireAlann ❑ Fire District FD 01
El Fire Hydrants/Lock box El WA DOT
❑ Critical/Hazardous Materials ❑ Special Inspection
❑ Grading 0 Record drawings/Stormwater
El Demolition El Utilities/Liberty Lake Sewer Dist.
❑ Free Standing Signs ❑ SRHD:Schools/other
❑ On Building Signs ❑ SRHD:Food Handling
❑ NREC ❑
❑ Special Inspections ❑
Certificate of Occupancy Worksheet Last Update: 10/26/01 Updated by:J.D.LARSON
Approved for TEMPORARY CO- Field Inspector: Date: Code Coordinator:
Expiration Date: Fee:
Conditions:
Approved for FINAL CO- Field Inspector: Date: Code Coordinator:
Conditions:
MAIL CO TO: PHONE: ,/� --- o?
ADDRESS: V',;/ 7 p7 /
Date Comments