1981, 05-20 Permit: 81A-4960 PoolPLAN NUMBER r._, r4,--
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 , -4-IIS \-\ cu3 .)
LEGAL DESCRIPTION — SEE ATTACHED
LOT
2. TS
BLOCK
SUBDIVISION
Ve -r WtEAocu,'S IST
OWNER
g. . tui . `2RL' 1CL7
ADDRESS
.4tt5 14ou.D1e
HONE
24-x31!
PARCEL NUMBER/S
3354-3 - ICS*
ZIP
Cleigat
Actual Set Backs in Feet
North (South Lo
1
East (West
4.
CONTRACTOR
iiDLt Dkke `DOOL6
PHONE
etaS-4eicO
Size of Parcel
cic, -
Zone Classification
SiT.J&L£ tgmtL'1
ADDAt ESS
rY I , Ser 14704
ZIP
C142.14 -
Type
i4 -
Type Const.
Occupancy
Sprinklered
❑Yes ONo 0 Req'd. .
5.
DESIGNER
PHONE
Val tion
,I'7:COD
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
I 'NEW 0 ALT. 0 AD N. 0 RPL.
0 BLD. 0 PLMB. 0 MECH. 0 M.H.
DESCRIBE WORK
8. RE5iDENITtvtL elax M rvt
❑ PINE.
SPOOL
IEx36
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not,eq'd.
Enum. Dist.
Location (Area)
it VALUATION
9.1I3,boo
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
SEPTIC.
Ownership USE CODE
Public 0 Private
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 n. . esume
to give authority to violate or cancel the provisions of any other state or local law r - t. a ing constru-o th
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env.
Planning
Fire Marshal
Co. Enginee
Utilitie
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
'Mobile Home
Other (Specifyl26tO6
S,Mn.NYYDoI-
TOTAL $'LS.00
pe ' r 7MBER-
06i--zr-0co
02:* *25.00
*2500 �.
*25006
A *0.00
86f1'2
0/ '.23'-81
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'y
•
DATE ISSUED
49'6,'0`'5, *2:5.0.0° J
PERMIT NO. TOTAL
0.
O
J
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1- /Ynr.)(Trtlit _�l. kOLLC)�A
LOT G f3Locg (CIO
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•
TI(5 _ FloLt_E,UJ
Is'
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zoo
115
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