1983, 03-15 Permit: 83A-1875 PoolSTREET ADDRESS
LOT BLOCK
2. OWNER
3. N
MAILING ADD
CONTR•CTQR
4.
�- 6
DESIGNER
5.
ADDRESS
r% IF r `1`V/1 I TVI'M / r Fm"IVI II 1
SPOKANE COUNTY DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
PARCEL NO.
G 1 1
SUBDIVISIO14 LEGAL DESCRIPTION:-�
V N PHONE �00 LU r4-
G I :�� G. 'N'orth w �„- � South East I West
LICENSE EXPIRES HONE Size of PaWel Zone Classification l
ZIP Type Cortst. Oocu ncy Sprinklered
,J ❑Yes 1:1 No ❑Req'd.
PHONE New Const. Valuation Remodeled Valuation Total Bldg. Floor Area
ZIP j Main Floor I Upper Floors I Garage/ Storage I Greenhouse
CHANGE OF USE FROMTO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW ❑ ALT. ❑ AD' N. ❑ RPL.
E7
OF
7Certifi.
I
WORK ❑ BLD. 13PLMB. ElMECH. ElM.H. OL❑OTHERofExempt.
Required
Yes 11 No❑
Number
or Variance
Received
Yes El Nor-]
DESCRIBE WORK
8
Shorelines/ Flood Hazard
Plans Required Ll
Ct9V
Yes Not Applic. ❑
Received ❑
9
ALUATION
Q
SOURCE GA
ELECTRIC
WATERV
PUBLIC �
SEWAGE
SEPTIC
Ownership
Public ❑ Private
/T
FEES COLLECTED
(�/
LI
UTILITIES
PRIVATE ❑
SEWER ❑
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
Building
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
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
DATE
OWNER OR AGENT DATE aL_.y_ —
Mech.
SPECIAL APPROV LS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. Fit DATE
Plan Check
Env. Health
Planning
Utilities
Plans I I I I PERMIT IS NONTRANSFERABLE
Exam. I � 4=�I I PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building -, IN 180 DAYS
SEPA
Modular/
MFG.Home
Other (Specify)_
TOTAL $ I
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS
((��BECOMES A PERMIT. L
DATEYSS��jjUED` 5 8•.3 PERMITj gQ .7.6 5 * 2 5, 0 0 tor OITJAL
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