1984, 12-13 Permit App: 00003758 Remodel • 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 (last) (first) (m) I Department Use Only
k2e it.0S &Rem R fes. Comm
2 Project Address(not Mailing Address)ix Road Name Space Zip
E. IC)/ 7 /1-r-jJ j-ThC, 7 1,7C1
3 City/Community State Subdivision/Plat Name
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4 Assessor Parcel No. Lott/v Block
( * * * DEPARTMENT USE ONLY * * *
Lsil4 — tY a in-16' ) 10 V i( �6
5 Sic Code Zone Act.# Zone G Project No. r3 ifs
6 Dwell# No.of Buildings �Sq.Ft./Acre Depth f Frontage
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( /4v(/7
7 Set Back-Front (L)S-1 (R)S-2 Rear Census Tract Module No. Initials
E-IN1 N(�, -. UJ (Y\
* *
16 Architect Firm Name Street Address
Zip City State Phone
( )
Contact Person Phone If different than above
( )
Contractor Firm Name Street Address
Zip City I State Phone
( )
Contact Person License No. Phone If different than above
( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
(.S-Cel ) �102Z- 1/I
12 Review Required Plan Check(YIN) Other(Y/N) I SEPA Exempt(YIN) Date
15 Type Work ❑ Bldg ❑ MI-I 0 New ❑ Replace ❑ Other
0 Fire ❑ Demo * Add/Alter ❑ Move
14 Describe Work
tY ^K �.fes(l�`C UO.S1
10 Applicant Name ��l/� Street Address
11 Zip City State - Phone
( )
* *
Street Address
Lender
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information ���� '''z
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5-�G�S )
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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
Release w/cond 1 Hold
Environmental Health n Commercial; ❑ Residential
W. 1101 College ❑ New Construction; ❑ Bldg alteration/addition 12.1 3—€'/ J'
Room 200 ❑ Additional structure; I
APPLICATION#
Conditions Comments: •. .
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; I I
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N.811 Jefferson ❑ drainage ❑ new access/approach; 0 fence;
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
❑ Plan Exam
Fire Prey.
Conditions/Comments:
a
co
Project Representative
Telephone
Agencies Performing Special Inspection:
cn
Y o 1•
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1O c
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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
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SpolTne County
Health District
III I
West 1 101 College Avenue Spokane,Washington 99201Itommiligl II
December 13, 1984
Mr. Marc Richard Roecks
East 10117 - 16th
Spokane, Washington 99206
Re: Waiver request for deck at East 10117 16th.
Dear Mr. Roecks:
Reviewing our records on the sewage disposal system at East 10117 - 16th
Avenue, and your request for a waiver, we have come to the conclusion
to grant a waiver whereby a small portion of the sewage system will be
seven feet from the proposed deck, whereas the required distance is
ten feet.
If you have any questions, please feel free to contact the district
at 456-6040.
Sincerely,
ENVIORNMENTALHEALTH DIVISION
Dennis K. Kroll, R.S.
Director
cc: Building Codes V
if
Administration 456-3630 Personal Health 456-3613 Environmental Health 456-6040
Clinic 456-3640 Viral Statistics 456-3670 Laboratory 456-3667
An Equal Opportunity Employer