1983, 06-14 Permit: 83A-5268 PoolPLAN NUMBER I APPLICATION/ PERMIT
-*► -SPOKANE COUNTY - DEPITNF`NT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKA . E, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
2 I1v BCK StfBgivlstON� LEGAL DESCRIPTION:
OWNER I
1L�
N
PHONE
M G A D S
� �
ZIP
Actual Set Backs in Feet to:
North lU jSo.th East
West '7
CON T R
LICENSE EXPIRES
PHONE
SI Parcel
%
one lassifi io
Residential
Commercial ❑
4.
ADDRESS
ZIPType�C¢nst�
Docu ncy
Sprinklered
�f� r
Dyes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
TYd
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
NEW El ALT. El AD'N. 1:1 RPL.
7•
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M. H.
El MVE. 1:1 OTHER
0001_
Certifi. of Exempt. Required
Yes No El
Number
or Variance
Received
Yes ❑ No ❑
8 DESCfB W R �� �U� �'
J
'�
Shorelines/ Flood Hazard
Plans Required ❑
t
NotApplic. ❑
Received ❑
L�IATJON
9 ��
IYes❑
SOOUFCE
GAS
ELECTRIC
WATE/
PUB ICSH
SEPTIC E
a'''�hip
Public ❑ Private
FEES COLLECTED
UTILITIES
PRIVATEEE ❑
SEWE ❑
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
I
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF����
APPLICATION
OWNER OR AGENT f`
DATE
Mach.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health j ,
';r's. roc6 04: 4 Ifh � ro . -Co '� 1 trvs-C Oct r.iEO
Planning �2►c -M TNS F'k{i�N(, O __RknD-
Prevent.
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building
Tech. IN 180 DAYS
, (Zi ,f _
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ :" '
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. SS
DATE'`IUED� 4 _ PERMIT5,,�.6 8 z
*25.000]
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