1979, 10-01 Permit: 79-5002 PoolPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
JOB ADDRESS
LOT
2. „n—
ovo, NfR
7OWNER I
3 ;74/. ,�:GL (.1 -:,te
ADDRESS •
CONTRACTOR
BLOCK
SUBDIVIS,O1-1N
4' ADDRESS
x.:
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
x.07.3_
A AS OD
ZI P
Required Set Backs in Feet
North 'South
East 'West
PHONE
Size of Parcel
ZIP
Type Const.
Occupancy
Zone Classification
Sa1�L ytLGf `t L -v;'
prinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5, ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
,5XyJ
ZIP
DWL Area I Basement Area
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N. ❑ RPL.�❑,rMVE.
❑ MECH: ❑ M.H. I� POOL
0 OTHER
No. Baths
y,1 Rancher
Y' 14�'(%bvLiL'i.-L(cf ' /i-.1A�(- -
No. Floors 1 NO. Rooms
CERTIFICATE
of EXEMPTION
Split Level
Req'd.
Rec. Room
Rec'd.
Not Req'd.
8.
VALUATION G`)
9. JC)T&,.__
DESCRIBE WORK
urce ELECTRIg
So
of
Utilities
GAS -
WATER
SEWER
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 regulating construction or the
performance of construction.
DATE —ti 7 77 SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
DATE
OFFICI
APPROVE 413R ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
PERMIT NUMBER
DATE
02* *2500
*2500 to -
*25.006
B *0.00
5001
10-01-79
6,479.
P
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0_
cn
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS 1TOIXIE1$,AEzi3MIT. - i1 c, 2 z
* 2 5. 0 E. P
>TO
L..
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