1984, 04-05 Permit: 84A-2954 PoolPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
LOT
2.
BLOCK
3.
SUBDIVISION
OWNER
1)1lJ CRUST
MAILING ADDRESS
-
CONTR
4. f T R 2Pa, root, ��,/ I�tJ C, p
AD7ESS 5 1 c b se o
PHON
g2 -'31%
LICENSE EXPIRES
DESIGNER
ADDRESS
CHANGE OF USE FROM
PHONE
ZIP
PH NE
56,4
ZIP/g".7
PHONE
ZIP
TO
TYPE ❑ NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OFOTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ElM.H. POOL ❑
PARCEL NO.
LEGAL DESCRIPTION:
Actual Set Backs in Feet to: ,
North 2i S J 'South •SS I East
Size of Parcel
Type Const.
Occupancy
New Const. Valuation
Main Floor
No. Baths
Certifi. of Exempt.
or Variance
West
Zone Classification
1_4 f!N6
Residential ❑
Commercial ❑
Spr'nklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Upper Floors
Total Bldg. Floor Area
Garage/Storage
Uncv. Deck
No. Floors
8. DESCRIBE WORK
(. ' 3c» Su.) poo l
VALUATION
9.
SOURCE
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE ❑
SEWAgg.
SEPTIC
SEWER ❑
Greenhouse
Fin. Basement
No. Fin. Rooms
Required Yes❑ No❑
Received Yes No❑
Shorelines/Flood Hazard
Yes LI Not Applic. ❑
Ownership
Public ❑ Private ❑
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 au-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF _ APPLICATION �,1 t�
OWNER OR AGENTS l L �- DATE t L --1
SPECIAL APPROVALS
PRELIM. Fl AL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Requ'red ❑
Received ❑
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other 01-,i'y1
pC
TOTAL $ .°
PEAT MIT NUMBER
ei-VA-? S4
02* *2500
*25006
A *0.00
287.68
04-03-84
6479•
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEISSUED 5 -
PERMI12N . S' `t z
*25.00AL