1986, 05-20 Permit App: 00011168 Pool(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK'•/
(Please return this original and your building plans to the Department of Building and Safety)
JYIAUCU Mr1CMJ Arm run UCYMrt I IVICIN I AL UJC
Project Number / / 4,�J Q
I
Owner's Name LAST FIRST MI
LOBDELL DAVID M
Project Address (Street Name & Number) Zip
E. 11709 GRACE, SPOKANE WA 99206
Applicant
IMPERIAL POOLS, INC.
Address
N. 5150 FREYA
City
SPOKANE
State
WA
Zip
99207
Phone
(509) 489-5674
Business Phone
( 1 SAA
Contractor/Agent
IMPERIAL POOLS, INC.
Address
SAA
City
SAA
State
SAA
Zip
SAA
Phone
( ) SAA
Contact
Bobby Walsh
License Number (Required)
IMPERI*227PT
Business Phone
( ) SAA
Architect/Engineer
IMPERIAL POOLS, INC.
Address
SAA
City
SAA
State
SAA
Zip
SAA
Phone
( ) SAA
Contact
SAA -
Business Phone
- ( ) SAA
Lender
Address
City
State
Zip
Phone
( 1
Describe Work ' `, p� y�.7 1�� (� �p
C W �' 1 1 t u'„� Y &O L`
Res. V
Comm.
Subdivision/ Plat Name/Short Plat Number
t.%AE1PR'
Assessor Parcel Number
Dcic1 i - dS (8
Lot
IS
Block
5
Plat Number
Pertinent File Numbers
Zone p
l,t/�SU4
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
1
Lot Size (Sq. Ft./Acre)
Depth
Frontage
Front Setback 7 I f ��
lEtX
Left Setback -
Right Setback
Rear Setback f
26
Additional information
I DEPARTM ENT USE I
Square Footage
Building Technician
a m
Date
SiVe5(
- _
Group
M -i-
Type
VN
DEPARTMENTAL
DEPARTMENTAL REVIEW
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent is true, correct, legal, and binding.
Owner's Signature Date
Approved
Cond.
Approval
Hold
Environmental Health Permit Number
E
�
' ( i
�J1,U_)`Y
p
A
R. 1101 College
R000mm200 (,
Planning/Zoning
N. 721 Jefferson
Permit Number
Engineers
N. 811 Jefferson
Utilities
N.811 Jefferson
l
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Crlticat Material/etc.)
Fast Track/Special inspection Information
Project Representative
Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent is true, correct, legal, and binding.
Owner's Signature Date
IMPERIAL POOLS. INC.
N. 5150 FREYA
SPOKANE. WA 99207
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ynvc Fo1J[�cc c
E, //70 7 GRACE
S MANE WA. nag
70244-x793
7"
//WWSE
REAR P4-
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