1982, 06-03 Permit: 82A-4467 PoolPLAN NUMBER 13111111W APPLICATION/PERMIT
SPOKANE COUNTY — BUI;!„DINW CODES DEPARTMENT
d NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LEGAL DESCRIPTION —SEE ATTACHED
2. L OK PARCEL NUMBER/S
OWN
KJ
SLR —J PHONE3.
,-( 4
ADD ESS P Actual !rocks in Feet
North South East West 0
CONTRA TOR aP�HONE Size of Parcel z,�ne, lassification
4. ADDESS if Typ onst. Occ pancy Sprinklered
Dyes ❑No ❑ Req'd.
DESIGNER PHONE Valuation Building Area in Sq. Ft.
5. ADDRESS ZIP Main Floor I Upper Floors Garage Area Storage
CHANGE OF USE FROM TO Area of Decks Finished Basement Unfin. Basement
6.
TYPENEW ❑ALT. 1:1 AD -N. ❑ RPL. ID MV
Baths No. Stories No. Rooms No. of Dwellings
MV
7, OF OTHER
WORK ElBLD. 1:1PLMB. 11MECH. ❑ M. H. POOL CERTIFICATE Req'd. I Rec'd. Not q'd.
of EXEMPTION
DESCRIBE O i O�� Enum. Dist. Location (Area)
8 N Zox 41c) FEES COLLECTED
VAL�U%AT ON SOURCE GA ELECT IC WATER SEWER Ownership USE CODE
9. A / UTILOITIES Public El Priv Single $
1 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 O'erning this Building
type of work will be complied with whether specified herein or not. T e anting of a permit do not presume
to give authority to violate or cancel the provisions of any other stater lo*I law regulati cons ction or the
performance of construction. EE EVERSE SIDE FOR REQUIRED I SPE IONS Plumbing
DATE OF APPLICATION SIGNATURE OF APPL4��"—
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
inic PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
PERMIT FNUMBE�R.�
v`2fi
Plan Check
SEPA
C
C
C
Mobile Home
L
Other (Specify)
L
f
TOTAL $�
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'0161,1-t Y -�gi 2' 446 7 Z
* 2 5.0 0 a _
DATE ISSUED PFRMIT NO.
TOTAL
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