1978, 01-23 Permit App: M4621 ResidenceCounty of Spokane, Washington
BUILDING CODES DEPARTMENT, N. 811 JEFFERSON, SPOKANE, WASHINGTON 99201
APPLICATION FOR LAND USE OR STRUCTURE PERMIT ��//
GENERAL REQUIREMENTS PERMIT FEE ._.._I__ YY..
1 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 must conform with the
Spokane County Building Code and Zoning Ordinance. Construction is subject to inspection.
' NATER. Nater 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.
APPLICANT FILL IN BELOW THIS LINE
Name of Owner L E/VTEQ/r.F>S fS Address Phone
Architect Address Phone
Engineer Address Phone
Contractor _'j /9 sfst L- Address one _
Legal Description of Property(Give complete description from deed, tax receipt, etc.) Parcel Number t6If
-SJ0 Z--
Tn :1/.fd S i TE --
DESCRIPTION OF WORK: New Addition Remodel Moving Bldg. Zone —� Fire Zone
Size of Lot % d� X / 3 0 Sewage System S�`'T�G Const. ArA,4/`4�,
/tCtt.i _ �L}2t]"_ (Fr., Conc., Br. tc.)_ PC?
Stories I Dimensions :E X 26 P"4 O=rn
tlT �q X 2-y Total Sq. Ft. �' 0 Valuation 9✓'D
Rooms Baths 27 BasementFoundation Const.. t!'�we� Chimne replace �
(Full, part, nones (Kind) (Number
Heat. System 4. r-4 f- r Type of Roofing C fazW Ext. Finish f�/1A.22� Int. Wall Finish
Use of Bldg_'5/W4/& !_,ev)Q" No. of Units—Bedrooms
PLOT PLAN
Draw sketch with dimensions showing: (1) property lines; (2) street or road locations; (3) location of existing and
proposed buildings; (4) distance to property lines and streets; (5) dimensions of buildings; (6) location of sewage sys-
tem and water supply lines.
NORTH
State License No.
Ind. Ins. Acct. No.
RESIDENTIAL - COMMERCIAL
REQUIRED
Plumbing Permit
M Heating Permit
HSewage Permit
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
SOUTH
I hereb of infortion s tted is correct and there are no other structures located on this property except
as shown.
Owner or Agent Date c�
A LAND USE OR STRUCTURE P RMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOT A PERMIT.
DO NOT WRITE BELOW THIS LINE
Your street address will be L m' X02 e zone is
Sewage Permit Number IpsueP Building Permit Receipt / Issued
Remarks -n'I
Form 523 Bldg. Code
TAX SEGREGATION APPLICATION FORM
(Applicable to the division of one or more parcels of real property into
twV or more parcels under different ownerships, also applies to
aggregation ofya}rcels _) J
NAME
ADDRESS ----
r*
PHONENUMBER DATE
DELINQUENT)/
TAXES PARCEL NO(S) ✓ "� ���
1. Enter legal descriptions of all portions to be segregated. Also
include legal description of portions remaining (use supplemental
sheet if needed).
II. Make drawing of entire property. Indicate approximate dimensions
of all property lines. Indicate on which portions of property any
buildings should remain. If a copy of a survey is available, please
attach to this form.
III. This application is to be completed in its entirety before processing.
NOTE: The approval of this application by the County Assessor or his
appointee shall not be construed as authorizing the division of lands for
thepurpo sof sale or subdivision in violation of RCW 58.17 (Plat and
Subdivisi Act). The taxpayer is hereby advised that no segregation
will take ace until this f rm is complete .
Aimlican gnature
THIS AREA FOR USE BY APPLICANT FOR LEGAL w
DESCRIPTIONS AND DRAWINGS. USE REVERSE SIDE IF
NEEDED.
I"
V