1981, 07-02 Permit: 81A-6618 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 3.COPIES
JOB ADDRESS
1. 3 al 9/C/2/-44 /2-7n fW/aa
LOT
BLOCK
SUBDIVISION
,f J.
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
.114/11 /51•
ADDRESS �/
.S, r / p /,S_ %„0,3„4.7,,q.,,//a 6A /I p d
PHONE
yah-riz6
ZIgP
fla6
PARCELNUMBER/S ,7fr 90/7
/ L/KL/ NV 6rr�
Actual -Set Backs in Feet I l✓
North(South [East 'West ✓
CONTRACTOR
Fmpirr
4. ADDRESS
F39/8 Dee.vlTL,r•
5.
Pao IS _th C
PHONE
get- 7‘i.5--
5120
66.5
5120 of Parcel
.S fleYt 5 ^
DESIGNER
ADDRESS
sync
ZIP
Type Cgnst.
VN
Occy7ncy
Zone(C�lassssiffiiccaatiti-on
/ ` 1 Sprinklered
❑Yes ONo 0 Req'd.
PHONE
Valuation
//) 0*0
Building Area In Sq. Ft.
ZIP .
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfln. Basement
7.
TYPE
OF
WORK
E NEW
0 BLD.
0 ALT. 0 AD N. 0 RPL.
0 PLMB. 0 MECH. 0 M.H.
❑ MMVE.
LLT POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'tl.
Recd.
No>< d.
DESCRIBE WORK
8. asi cy 6ncrL SCUT rr, miry
ee c'.
Enum. Dist.
Location (Area)
VALUATION
s./1,000
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private
USE CODE
I hereby certify that 1 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. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION ` S 0 - SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Plan Ing
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
art
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home 2.5
Other (Specify)
F001
TOTAL $
PE R MIT.W,i-S0BFS
sl#. -Co(Pig
022 * * 2 5.0 0
*2500 1
*25006
A *0.00 g
65'7.72
07“,01-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
6'61 851.
oo ¢�
4"arroliaz"-'81}-11
DATE ISSUED PERMIT NO. TOTAL
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