1985, 07-11 Permit App 00006344 PoolBUILDING 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) Cepertment Use Only
uTL /�—C �. Comm
2 Project Address (not Meiling Address) a Road Name Space ZAP
o yo v rc T a.
3 GtylComrryynity
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4 .Parcel No. — ����
5 Sic Cade Zone Act. M
State Subdivision Plat Name
�vF>tt I L �- AV
Lot c-(' Black
+ DEPARTMENT USE ONLY x x +
7Pro,-t
Zone �� a6
Dwell a
No. of Buildings
Sq. Ft.I AcreDepth
Frontage
7 Set Bads -Front
(L)S-1
(R)S-2
Rear
Wnsua Tractule
No.
Initis
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16 Architect Firm Name
Street Address
Zip
city
State
Phone
1 )
Contact Person
Phone if different than above
Contractor Firm Name
n, '
Street Address 12b
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Z/ �yDa GTy �ivt!AnTf
State
(v�.
Phone q Q (', q
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Contact P{son
License No.
Phone if different than above
S Owner/Agent (if different than N1 above)
Business Address
S Zip
City
State
Phone
( 1
12 Review Required
Plan Check (YIN)
Other(YIN) SE
PA Exempt (YIN)
Dale
15 Type Work ❑ Bldg
❑ Fire
❑ MH
❑ Demo
�C New
C Add/Alter
C Replace
C MoveTT-
Other 7s/1A1Mr°
14 Describe Work
10sCa-nt1Narty\�
S, C"j /�+� 2A+
Street Address
11 Zip City
State
Phone
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone if different than above
1 )
Additional Information
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Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
Environmental Health
W. 1101 College
Room 200
Conditions /Comments:
DEPARTMENT APPROVALS
This is not a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
❑ Commercial; ❑ Residential
❑ ,.New Construction; ❑ Bldg alteration/addition
Additional structure;
APPLICATION # 84 —0I fL
Release
w/cond 1
Hold 2
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
0 Other
Conditions /Comments:
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N.811Jefferson 0 drainage ❑ new access/approach; 0 fence;
❑ road improvements
Conditions/Comments:
Utilities:
N. 811 Jefferson
Conditions/Comments'
Other:
Plan Exam
Fire Prev.
Cond i tlons /Comments:
Project Representative
Agencies Performing Special Inspection:
1
Telephone
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
SPOKANE COUNTY HEALTH DISTRICT
ENVIRONMENTAL HEALTH DIVISION
FINAL INSPECTION FOR SEWAGE SYSTEM AT and range and road)
(numerical address or lot and block in plat or section, township, Plan ,,'`�
Please fill out in heavy dark line (felt-tip pen or equal) with a straight edge.
is to include outline of structure (if available) as its positiodnaoccurs oninhe,prop-
erty. Identify by measurement actual location of septic
iints ank, drat o i ld lines, \\
drywell, or other on -site sewage facilities, property
on -site well (when applicable), driveway, and road frontage. Septic tank access
must be referenced to a known fixed surface structure.
NORTH
At
FINAL INSPECTION MADE BY
COMMENTS:
(INSPECTOR'S NAME)
(DATE)