CATALDO E 5622 JAMES BLACK STORAGE BUILDING
PLAN NUMBER APPLICATION PERM IT PERMIT NUMBEf
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
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, NORTH 811 JEFFERSON ! SPOKANE, WASHINGTON 99260 !(509) 456•3675
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APPLiCANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES :2 :2 :2 2
STREET ADDRESS PARCEL N0.
9~ El Rj~ D
3t ~
E , 5~ ~~A I
Lor BLOCK SUBDIVISION LEGAL DESCRIPTION:
2 Z Z~ 13, '°r~W N 01F AP-:Di,.EY
OWNEfi PHONE PHONE go cc ra cc ca Go m
~ I v OJ G) GJ CI G1 G!
3• Actual Set Badca In Feet to.
.
MAIUNG ADDRESS ZIP
r~atn ~ $ sa,tn ~ w~,t
CONTRACTOR IICENSE EXPIRES PHONE SizB o1 ~e1 Zone Classfliptlon Reeidential ~
c. 1C ?C 1 a(~ #^A 11--76.. Gbmmerciai
4
. ADDRESS ZIP Ty,paCanst. Occupancy Sprlnklered '
❑Yes ONa OReq'd. ~
~
1Q, aQ0 N1 N g Z
N c~ at~ ~
DESIGNER PHONE NewCorol• Valuation Remodeled Valuation Total Bldg. Fioor Area 0
ADDRESS ZIP Main Floor Upper Floors GaragelStorage Greenhouse
5•
cc ~
4
CHANGE OF USE FROM TO Cover Dedc Uncv. Deck Fin. Ba4ement Unfin. 8asement 0 ~
a -
6. c c ~
' No, Baths No. Flooro No. Fin. Rooms rb. Oweltings 0 0 0 ~
TYPE ❑ NEW 0 ALT. ❑ AD' N. ~ RPL. 0 MVE. U i u ~o
C
7, pF 0 OTHER ro ro v
BLD. C PLMB. 0 MECH. 0 M.H. ❑ POOL Cerllfi.ofExempt. Required Yea❑ NoeT Number ao
~ WORK aVariance Reoeived Yes❑ No0 ~ C *4 ~p
,a
~ 0 '0 d
'C
,
y y 3
'
OESCRIBE WORK ShaelineelFlood Hazard Plans Required E!I 9-4
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8' e'F C',E C-7 =3~ C T3 Yes❑ Not Applic. D Received u
~ I 'C
~ ~ • • 0 ~f
VAIUATiON SOURCE GAS ELECTRIC WATER SEWAGE pWnership FEES COLLECTED
OF PUBUC SEPTIC 3 3 ~ 0~
bp • • 'C
9• UfIIITIES PRIVATE 0 SEWER 0 Puak 0 Prfvate to/
G O O
I herebY certilY that I have read and examined this applicatian and have read the "NOTICE" provisions included on o
,
e a►
reverse side, and know the same to be true and correct. AII provisions of laws and ordinances 9overnin9 thls tYPe of
th whether specified herein or not. The 9rantin9 ot a Permit daes not presume to give au- J 4 „ o a
work will be complied wi > ~
thority to violate or cancel the provisions of any olher state or local law regulating construction or ihe performance a 0 4-4
C3
- g 'j z
w v8 ~
of constructfon. SEE REVERSE SIOE FOR REQUIRED INSPECTIONS Plumbin
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SiGNATURE OF APPLICATION
OWNER OR AGENT DATE Mecn. °p 0) ~ ° ~ C
u u a) a) a
C C ~ 00 C C 6
SPECIAL APPROVALS SPECIAI CONDITIONS: (SEE REVEFSE SIDE FOR NOTICE) Q► co [ c 66 ~ ~ v
Plan Check s ~ ~ 0 ~ v
PflELIM. FINAL DATE u 4v $4
w u > b ec
Ertv. Health „ Cl 9 y 0 0~ c0
• SEPA 3S .170 ~ u N Cl ~0 1+ 0
C+~ CI C CL G 0
pfanning 0 fvl v m a' ~ ~ H
/ oduler! Z ~ OG
~ MFG. Hame 0 rA +4
Fire CJ u c0 4! 'O 'd 'L7 00 F+
Prw", s~ c 3 ~ o z a
~ A IY U U
d 0
Other (Specify) 4+ a
' Engineer p
` . . . . ~ • • .
N w N cn ~.i N N1
Utilities
TOTAL $
0
~ U
SEPA
WHEN MACHINE YALIDATED IN THIS SPACE, .
Plaru PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT. • •
H
E°"'' >
PERMIT IS NULL AND V010 IF WORK HAS NOT COMMENCED ~
BuildinU IN 180 DAYS ~
Tech• DATE ISSUED PERMIT N0.
i
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S ~ .
Pl an 84A-1587 ~
a
~ TNR E S H UL-U DETEKM 1 NNT I UN
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PRUPUSED/FINNL DECLNRATIUN UF SIGNIFICANCE/NUNSIGNIFICANCE
1. Proponet. _ James S. Black, Columbia Building,^Spokane_99204
Contact Person : James S. Black Phone : 838-2511
'2. County's Action Keyuested: t3uildiny permit/Land use permit
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~ Pursuant to WAC 197-10-203, the Spokane County Uepartment of Buildiny and
Safety, a division of 5pokane County, has determined that the county, as an
ACTING AGENCY, is the LEAU AGENCY fnr the following project:
5,000 square foot warehouse - re-erected_building
Ttiis Uroposal has been deteriiiined to n ot have a siyinificant adverse impact
on the environment. An E1S is n o t reyuired under RCW 43.21C.030 (2)(c).
Tnis decision is inade after review by the county of a completed environmental
cliecklist and other information on file with the lead ayency.
*k7tk****~tir****~r7tk~F*~ric*~tkt~k*tir*t~ci•kkk*~r~*~ryttytk**k7Y~k*~*t~lrt*tlc~c *irir/rYk/ric*~r*kk*irk
, 1 f y ou wi sh to exerci se y our opti on to revi ew and coiniiient as provi de i n WAC
197-10-203(3)/197-10-340, please respond, if appropriate, at y our earliest
opportunity, notiny particularly the due date for written comments.
' Due Date for Wri tten Comments : March 12, 1984
Proposed Uecl arati on of Nonsi yni f i cance I ssued : February 24, 1984
Contact: Spokane County Uepartment of E3vilding and Safety
North 811 Jefferson Street
Spokane, bJA 99160 (5U9) 456-3675
Attent i on Kenneth E. Jeff r.ey
} PKUPOSED DECLARATIUN FINAL DECLuRATION
Name : James L. Manson Name : Jaines L. Manson
Siynature: ~ Siynature:
,
, Title: Director Title: Director
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Department: Building and Safety Department: Buildiny and Safety
Uate : February 24, 1984 Date :
MAILING LI5T
TU: Spokane County Planning Department
Spokane County Engineering Department
Spokane County Utility Department
r Spokane County Prosecuting Attorney
Air Polution Control Authority
Spokane County Health District
` WA State Dept. of Social & Health Services
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~ 'J;~ ENViRONMEN?AL CHECKLIST
r"E FILE I-oo
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SEC/7WN/RNG:
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Introduction: The State Environmental Policy Act of 1971, Chapter 43.21C, RCW, requires all state and local
governmental agencies to consider environmentaT vJlues both for their own actions and when 1lcensing private
- proposals. The Act also requires that an Environmental Impact Statement be prepared for all major actions
slgnificantly (and "adversely", as per WAC 191-10) affecting the quality of the physical environment. the
. pur-pose of Lhis checklisL is to help the agencies involved determine whether or not a proposal 1s such a
major attion.
Please answer the following questions as completely as you can wi*th the information presently available to
you., Please answer questions as "yes" or "maybe" if, in your opinion, even only slight impacts will result.
= The reviewefs of the checklist will be aware of and concern themselves with the deqree of impact, asking you
for snore information, if necessary. Where explanations of your answers are required, or where you believe
' an explanation would be helpful to government decision-makers, include your explanation in the space provided,
or use additional oaaes, if necessarv. You should include references to any reports or studies of which you
• are dwdre and which are relevant to the answers you provide. Complete answers to these questions now will
help all agencies involved with your proposal to undertake the required environmental review without unnec-
~ essary delay.
The following questions apply to your total proposal, not just to the license for which yov are currently
applying or the proposal for which approval is sought. Your answers shauld include the impacts which will be
~caused by your proposal when it is completed, even though completion may not accur until sometime in the
= future. This will allow all of the agencies which will be involved to complete their environmental review
now,'without duplicating paperwork in the future. No application shall be processed until the checklist has been completed and returned to the appropriate
- County deparUnent. State law reouires explanations for every "yes" and "maybe" answer on the checklist.
~ Ihe person completing the fo nn may be required Lo provide explanation for "no" answers, and in some cases,
more detailed informati.on to aid in a threshold determination.
HOTE: This is a standard form being used by all state and local agencies 1n the State of washington for
various types of proposals. Many of the questions may not aFply to your propasal. If a question
aoes not apply, just answer 1t "no" and continue on to the next question.
. ENVIRONMENTAL CHECKLIST FORM
~ I. BACKGROUNO .
ut
l. Name of Proponent: P ~ep e Number9~i
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2. Address of Proponent: 5O4) eWA40.
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3. Oate Chetklist Submitted:
►
4. Agency Requiring Checklist:
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5. Name of Proposal, if Applicable: •
0
•t~ 6. Nature and 9rief Oescription of the Proposal (including but not limited to its size, general design
elements, and other factors*that will give an accurate understanding of its scope and nature):
a
. .
1. Location of Proposal (describe the physical setting of the Proposal, as well as the extent of the land
area affected by any environmental impacts,'including any oLher i f3rmati4n needed to give an acturate
understanding of the environmental setting of the proposal): ' ~
'
8. Estimated Oate for Completion of Proposal:
9. list of all Permits, licenses or Government ~ ovals Required for the Proposal (federal, state, and
local - including rezones) : ~_~n,l_~
I-^
10a. Do you, or the awner in the event you do not own the subject land, have any plans for future additions,
expancion, or further activity related to or connected with this propasal? If yes, explain:
1
August, 1981 .
lOb. Do you own or, have optionson laRd•.nearby or adjacent to this proposal's location? If yes, explain:
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, .
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11. Oo you know of any plans by others including the owner which may affect the property covered by your
~ proposal or land adjacent or nearby? If yes, explain:
12. Attach any other application form that has been completed regarding the proposal; if none has been
completed, but is expected to tre filed at some future date, de5cribe the nature of such application
' form:
.
11. EhtV I RONMENTAL IMPACTS
(Explanations of all "yes" and "maybe" answers are required)
;
i. Earth. Will the proposal re5ult in: Yes Maybe No
(a) Unstable earth conditions or in changes in geologic subsctruc•.tvres?.
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(b) Disruptions, displacements, compaction or overcovering of the soill. ti
(c) Change in topography or ground surface relief features? . . . . . . . . . .
(d) The destruction, covering or modiftcatlon of any unique geologic or ~
physical featuresl . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(e) Any increase in wind or water erosion or soils, elther on or off the site?. ~
~ (f) Changes jn deposition of erosion of beach sands, or changes in siltation,
'i deposltion or erosionwhich may, modify the channel of a river or stream ~
~or the bed of t e ocean or any bay, inlet or lakel .
~ Explanation: VO a► AQ11""o "444"004~
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r .r...~ `t`~ ~ r.,~...~ t~t ~t~ p~-~ '~~~t~ t"~..~ ,
r~ . ~a.►~ ~ t~ ~~~r~, ~ pr~° I c- 1TW~ . . .
~ 2. Air, Wi 1 t~ proposal result in: Yes Maybe No
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" (a) Air emissions or deterior-ation of ambipr.t a1r Gu.-liiy?. . . . . . . . - ,
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(b) The creation of objectionable odors?, , , , , , , , , , , , , , , , , , , , , ~
(c) Alteration of air movement, moisture or temperature, or any chan9e in
} climate, either locally or regionally? . . . . . . . . . . . . . . . . . . . . Y
E x p 1 a n a t i o n: V~O AVCm
e .
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3. 4later, wi11 the proposal result in: Yes Mavbe No
(a) Change in currenLs, or the course or directlon of water movements, '
' i n ei ther mari ne or fresh waters? . . . . . . . . . . . . . . . . . . . . . . ~
,
(b) Changes in absorption 1-ates, drainage patterns, or the rate and
amount of surface water runoffl . . . . . . . . . . . . . . . . . . . . . .
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(c) Alterations to the course or flow of flood waters? . . . . . . . . . . . . . ~
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1 (d) Change in the amount.of surface vater 9n,any water hody? . . . . . . . . . . voe
~ (e) Oischarge into surface water, or in.any alteration of surface water ~quality, including but natlimited to" temperature, dissolved oxY9en
or turbi di ty? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(f) Alteration of the direction or rate of flow of ground waters7
(g) Change in the quantity of ground waters, etther through direct
~ additions or withdrawals, or throu9h interception of an , aquifer by cuts or excavations? . . . : . . . . . . . . . . . . . . . . . . .
(h) Deterioration in ground water quality, either through dtrect
inJection, or through the seepage of leachate, phosphates,
detergents,waterborne virus or bacteria, or other substances
i nto the ground waters? . . . . . . . . . . . . . . . . . . . . . . . . . . .
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(i) Reduttion in the amount of water otherwlse available for
public water supplies7. . . . . . . . . . . . . . . . . . . . . . . . . . . 2 .
x
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E x p 1 a n a t j o n : ~~f-4, I r elOr- ~'~~~`~•l~l C~"~+t ' ~i f wt.~ ep~~(-T .
~1 ~S►,.~ . . . . . . . . ~ ,
4. Flora. Will the proposal result in: Yes Maybe No
.
(a) Change in the diversity of species, or number of any species of'
flora (including trees, shrubs, grass, crops, microflora, and
aquatic plants)1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '
(b) Reduction of the numbers of any unique, rare or endangered ~
species of flora? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
~ (c) Introduction of new species of flora into an area, or in a
barrier*to the normal replenishment of existing species?. . . . . . . . . . .
(d) Reduction in acreage of any agricultural crop?. . . . . . . . . . . . . . . . ~
. .
Explanation:• . ,
5. Fauna. Will the proposal result in: Yes M•aybe No
(a) Changes in the diversity of species, or number-of any species of fauna (birds, land animals including reptiles, fish and
' shelifish, benthic organism$,insects or microfauna)? . . . . . . . . . . . . .
(b) Reduction of the numbers of any unique, rare, or endangered .
speci es of fauna? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(c) Introduction of new species of fauna into an area, or result ,
1n a barrier to the migration or movement of fauna? . . . . . . . . . . . . . '
(d) Oetertoration of existing fish or wildlife habitat? . . . . . . . . . . . . .
Explanation: - ' ' . ,
6. Noise. Yes FSaybe No
(a) Will the proposal increase existing noise levelsl . . . . . . . . . . . . ~
E x p 1 a n a t i o n : 1 I -rs To
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4rtA-'M III-VAA G~k
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1, liqht and Glare. ' • Yes Maybe No
(a) Will the proposal produce new light or glare? . . . : E x p l a n a t i o n : ~~1 1 ~ t ~ K.~ ~ . e'~ AT I I C"T' A ~el
. . . .t ti.,•;14'-r., . •
8. Land Use. Yes hlaybe No
(a) W111 the proposal result in the alteration of the present or.
planned land use of an areal . . . . . . . . . . . . . . . . . . . . . . . . _Z/
Explanation: . 9. Natural Resources. W111 the proposal result in: Yes Maybe No
(a) Increase in the rate of use of any natural resources? . . . . . . . . . . . .
(b) Depletion of any nonrenewable natural resource? . . . . . . . . . . : . .
Explanation: _TlAn'r_ir= llilATt~T&EG: LZ5 T-P-t A. c~1`"~~ ~
A-ExwC- I aJ C..r ci?,-)
. .
4
' 10. Risk of Uoset. Does the proposal involve a r.isk of an explosion or the Yes Maybe No
release of hazardous substances (lncluding, but not limited to, oil, .
pesticides, chemjcals, or radiation) in the event of an accident or
` upset conditions7 . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . ~
~ Explanation: ,
$
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11. Population. uill the proposal alter the location, distribution, density, Yes htaybe No
~ or growth rate of the human population of an area? . . . . . . . . . . . . . . . .
. Explanation:
P
t
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~12. Houstng. Wi11 the proposal affect existing housing, or create a demand for Yes Maybe No
. additional housing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
iExplanation:
13. Transportation/Circulation. Will the proposnl result 1n: Yes Maybe No
(a) Generation of additlonal vehicular movement? . . . . . . . . . . . . . . . . • ~
(b) Effects on existin9 Aarkin9 facilities, or demand for nex Parkin9?.. • . ~
(c) Impact upon existln9 transportntion systemsl . . . . . . . . . . . . . . . . ~
• (d) Alterations to present patterns of circulation or movement ~
of peopl e and/or goods? . . . . . . . . . . . . . . . . . . . . . . . . . . .
(e) Alterations to waterborne, rail or a1r trafficl . . . . . . . . . . . . . . . -Voor
(f) Increase in traffic haZards.to motor vehicles,.
bicyclists, or pedestriansl . . . . . . . . . . . . . . . . . . . . . . . . . ~
. Explanation: . . . , ~
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14, Publlc Services. Kill the proposal have an effect upon, or result Yes Maybe No
in a need for neW or altered governmental services in any of the
following arens:
. (a) Fire prvtection?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1~
1f
(b) Po11ce protectianl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
(c) Schools?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
s;. . .
(d) Parks or other recrEational facilities? . . . . . . . . . . . . . . . . . . .
(e) Maintenance of public facillties, including roads? . . . . . . . . . . . . . . vooo
s~
(f) Other goverrunental services? . . . . . . . . . . . . . . . . . . . . . . . .
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E xo 1 a n a t i o n:'U.p "U-P -Y" a'9U1 in
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3±~ 15. EnerqY, Will the proposal result in: Yes Maybe No
T
(a) Use of substantial amounts of fuel or energyl . . . . . . . . . . . . . . . .
.r ~
(b) Demand upon exi s ti ng sources of energy, or requi re
the devel opment of new sources of energy? . . . . . . . . . . . . . . . . . . <
~ E xp 1 a n a t i o n :
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y.; .
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: 4
L4e 1; 1 •
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16. Utilit{es. Will•the proposal result in a need for new systems. • Yes Maybe No
or a 1 terati ons to the fol 1 owing u ti 1 i ti es : .
(a) Power or natural gas2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~
(b) Communication systems? . . . . . . . . . . . . . . . . . . . . . . • . . . . . . .
(c) uater? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(d) Sewer or septi c tanks? • . . . • • • • • • • . . • • • • • • • • • • • • . • . •
,
(e) Storm water drainage? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . .
(f) Solid waste and disposal?. . . . . . . . . . . • • • • • • • • • • • • • • . • . • UOOO/
L
E x p 1 a n a t i o n: C~~T~ f Ca~~ ~1 ~ Z'~'~ .t~~~•r f.~ ~'~c'~~,. L~ t.~'a
/ 1 K/~~J`4~~J ! •`~l~~`Vrfij • '
, Yes Maybe No
11. Nunan Nealth. Will the proposal result in the creation of any health hazards ~
or patential health hazard (including mental health)?. . . . . . . . . . . . . . .
Explanstion: Yes Maybe No
18. Aesthetics. ut-ll Lhe proposal result in the obstruction of any scenic vista or
view oQen to the publlc, or wtll the proposal rESUIt in the creation of an ~
eesthetically offenslve site open to public view? . . . . . . . . . . . . . . . . . . ~
' Explanation; Yes Maybe No ; 19. Recreation: uill the proposal result in an impact upon the quality or
° quantiV of existinq recreational opportunities? . . . . . . . . . . . . . . . . . Explanation: • - ~
Yes Maybe No
20. ArchealoqicaliNistorical, Will the proposal result in an alteration of a
significant archeological or historical site, structure, object or building?
Explanation; ,
I I. S I GP(ATURE
I, the undersigned, sr+ear under the penalty of perjury that the above responses are made
truthfully and to the best of my knowledge. I also understa d that, should there be any will-
ful misrEpresentation or willful-lack of full disclosure on par . Spokane County may h-
draw any deciaration of nonsignificanc that it might issue i ance upon thi Date: Proponent:
(Please Print or 7yp
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Proponent: .ddress: ~ ~
Phone:
Person completing form: ~ ► . . Oate:
FOR STAFF USE ONI.Y
r(s)• Reviewi ng Chetkll s t: i
St a f f M b e
k-P
t Based on thls staff review of the environmentnl checklist and other pertiment fstaff:
A._e4 Concludes that there are no potentially significant adverse impacts and recamnends/issues
a proposed declaration of nonsiqnificance.
8. Concludes that potentially signiflcant adverse impacts do exist and recomnends/issues a
final declaration of sianifi-cance.
F C. Concludes that there are no potentially significant adverse impacts and, because of the
nature of the proposal, recormtiends/issues a final declaration of nonsignificance,. ~
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vi-std:: August, 1981 5 .
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PLANNUMBER . APPLICATION/PERMIT PERMITNUMBER EA.A ' 1S&n . .
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY NORTH 811 JEFFERSON ! SPOKANE, WASHINGTON 99260 I(509) 456•3675
L. .
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREETAODRESS PARCEL N0.
1. G ,S6~~- 14531-'~-v'~ti
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION: 5~, O O
of ~AZZL'cY t") b* * 3 5, 0 0
OWNER PHONE PHONE ~
~rrc,s S. ~ c..acrr - 2-S~ B 8 0 0 ~
MAIUNG ADORESS ZIp Aclual Set Backs fn Feet to:
~bl.l..~ ~n?aA~•. ~7 ~1 North I South ( Ea9t 4~ I West 8~ a O cYi
CONTRACTOR IICENSE EXPIRES PHONE Sizeof Parcel Zone Classlfication Reeldenlial q/ r{ * a 0 0 ~
~ TECZtz.H 1m c-~ 116 K 1 a0 ~S Commerclal C8 1~~ 7 z
AODRESS ZIP Ty,pa~Const. Oocupancy Sprinklered
~J, t3Aos N~wPo2T ~IlJ~f aao~ .,y,N ?j Z OYes ONo DReq'd. 02-24-84 ~ OESIGNER PHONE NewConst. Valuetion Remodeled Valuation Total Bldg. Floar Area
3. kqu04-l 4f5CxD - 647Q
ADDRESS ZIP Main Floor Upper Floors GaragelSlorage Greenhouse
~ CFiANGE OF USE FROM TO Cover Declc Uncv, Deck Fin. Bavement Unfin. Basement `
i
TYPE ❑ NEW 0 ALT. 0 AD'N. 0 RPL. Q MVE. No. eaths No. Floors No. Fin. Rooms No. DrveUfngs
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7. OF 0 OTHER ~
WORK ~BLD. 0 PLMB. 0 MECH. ❑ M.H. 0 POOL Certfif.ofExempt. Required YesO No~' ►vumber ,
aVarlance Recelved Yes ❑ No0 ~
DESCRIBE WORK 5horelineslFlood Hazard Plans Requlred 6
3. F_ ez, <-7 ~TG~-1C" E T'j;,t~.O+Iv(,~ Yes❑ NotApplic.0 Received ~
VALUATION 5a0FCE GAS ELECTRIC pUBLICRYJ SEPTIC ~ O'""ership % FEES COLLECTED
r
~j UTILITIES PRIVATE 0 SEWER 0 Public 0 Private 62~
I nereby certlfy that I have read and examined this applicalion and have read the "NOTICE" provislons included on
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing thfs type of gullding
work will be complled with whether specifled herein or not. The gra o( a permit does not presume to give au-
thority to violate or cancel the prov~l 'ons oi any othj~r state or local law reg ating construction or the performance ,
ot construction. SEE &fV'ERSE $WE FOR REO E INSPECTI NS Plumbing .
SIGNATURE OF C APPLICATIO ,
OWNER OR AGEN DATE Mech, ~
SPECIAL APPROVALS ~SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE) PlanCheck
PREUM. FINAL DATE 7:,~>'c7kS
Env, Hoalth
SEPA 3J^.00
Planning Modular! ~
~`(~~~'~•L~~~J'~.~{ ~~i(~ ~~vtu e--~ k2~ SC.I.a~~ MFG,Home
Flre ~ a
Prevent. 5C Zp /z0 , . O
Engineer Other (Specily) V
1 W
Utilities
SEPA TOTAL $ .
WHEN MACHINE VALIDATED IN THIS SPACE, .
Plans PERMIT IS NONTRANSFERABLE THIS BECOMES A PERMIT. '
Exam.
PERMIT IS NULL AND V010 IF WORK HAS NOT COMMENCED '
Building IN 180 DAYS
Tech.
,C ` J DATE ISSUED PERMIT N0. TOTAI
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