1981, 04-03 Permit: 81A-3075 Swimming PoolPLAN NUMBER
x/3/4/
APPLICATION /PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
3
4.
JOB ADDRESS
N 541-11 Pa ni►\,c1..;
LEGAL DESCRIPTION — SEE ATTACHED
LOT
OWNER
BLOCK
SUBDIVISION
`_51,01P4 j' oL
ADDRESS
N. 44f
CONTRACTOR
?c ,Et u.imaL .
UPI LLtiL[3
PHONE
61..1%:. CAA L`
PARCEL NUMBER /S Ls, ` it3R ^�
ZIP
(��
Actual Set Backs in Feet I
North %``v (South
I
[East 1 f // West
PHONE
Size of Parcel
Zone Classification
ADDRESS
ZIP
CACI
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Va
ation
Building Area in Sq. Ft.
511
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
EI NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑_/MVE.
[0 POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
DESCRIBE WORK • 8. Y.t/I.DErTi L wtr<oVviI -M..
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not SYeq'd.
1i
Enum. Dist.
Location (Area)
.}VALUATION ,
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private /
USE CODE
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regu sting co struction or the
performance of construction. SEE ' EVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICA
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ytqcling gchnician
,
SPECIAL CONDITIONS:
Ll6FNC C314,
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify / ' 0
TOTAL
$
PERMIT NUME"
A- -
02 *2500
* 2500
* 25.006
A *000
307,42
04,03 -81
2 6,479.
MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'4j 1 1
DATE ISSUED PERMIT NO. TOTAL
307..55- *25.00x1
7/
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