1981, 03-30 Permit: 81A-2860 PoolP/
0o/8/
arrLuca I ivni I
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1-/ ✓i1!,�1 -
LOT BLOCK BDIVISION
O�,✓v NER
ADDRESS
CO TRACTOR
4. �4 444 e
2.
5.
LEGAL DESCRIPTION - SEE ATTACHED
PHONE
ZIP
(lc -1Lei
PHONE
PARCEL NUMBER/S „i;:;„,s.5.1/ -. 9 7 '7l
reek" r Ex -e. s, zs' jpi-ac rov✓T)/
Actual Set Backs in Feet / (( /
North /4 (South/41i East a :/ 'West Q -/Y
Size of rarcel
go xi 76.
ADDRESS
A,44.a
DESIGNER
ZIP
Type Const.
Occupancy
Zone Cla§sificaon �}
4-1.1
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
S/2
ADDRESS
ZIP'
Main Floor
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unf in. Basement
TYPE
7. OF
WORK
NEW
❑ BLD.
O ALT.
❑ PLMB.
❑ AD N. 0 RPL. 0 MVE.
❑ MECH. 0 M.H. 54 POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
D ESCRIBE WORK
i0 (10 4/-44/64/4) z• ghlt X'
` WATER
VALUATION
• r o0D °6
I hereby certify that I haveread 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 permit doe not presume
to give authority to violate or cancel the provisions of any other state or local law r g c.,�Q�lction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONY /% / ///n'
CJV ^ vv/
SOURCE
OF
UTILITIES
GAS
ELECTRIC
Enum. Dist.
Location (Area)
SEWER
Ownership
Public 0 Private t2.
USE CODE
DATE OF APPLICATION
—36 —2/ SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME GATE
Fire Marshall
Co. Engineer
Utilities
Plans Examine
SEPA Checklist
• PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home ,!
Jt! i/W,L <�2i
Other (Specify)
TOTAL
$
0'2* *2500
*2500 rn
*25006
A *000 8
28592,
03.-30-8-1
2 6479
9
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
O!3t3�31`9; ;; 4i 2`8 0'z 0:0,2 -
DATE ISSUED PERMIT NO. TOTAL
'
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