1980, 10-07 Permit: 80B-1514 PoolPLAN NUMBER
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
1.
2.
3
JOB AD RE S
C
SUBDIVISION 0LOM�r V (5
.
LOT
OWNE
BLOCK
LEGAL DESCRIPTION - SEE ATTACHED
ADD
PHONE -930
`ifs
IP
PARCEL NUMBER/S o 4-1 - J n j
Actual Set Backs in Feet
North 'South (r? 5 1East 50
'West
4.
CONTrIiI - 1 W , rCJ
ro
ADS6�I 21\I
oj\J
-1566-?‘ I
Siz iof Parcel
Zone
lassiificaatlio
VV
(
Type Const.
ccupancY
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
ZIP
Building Are
Ft.
Valuation
500
Upper Floors Garage Area
Main Floor
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
7.
TYPE
OF
WORK
SNEW ❑ ALT.
❑ BLD. 0 PLMB.
O AD'N.
❑ MECH.
❑ RPL. 0 MVE.
O M.H. Cl POOL
8. i�l INs i ff Phot, (1 IF, x .� rte)
DESWATER
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Notf4d.
9.
VALUATION
SOURCE
OF
UTILITIES
GAS
ELECTRIC
Enum. Dist. I Location (Area)
SEWER
Ownership
Public 0 Private
VOSE CODE
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 authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEEREVERSESIDE FOR REQUIRED INSPECTIONS
Oar
/
DATE OF APPLICATION (Jar ' /F80 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
IA` 1/ -r() G OSI')fCK,
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other ( ec'ify)
TOTAL $
PEIMiT NUMBE.2
8o$-vs(4
* 25.00
* 2 5;0
* 25.003
* 0 ,0 S
1 3 5. 7
10-03-b0
27 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10
DATE ISSUED
15,1.4°z
PERMIT NO.
*25.00a�
TOTAL
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J
6
AlinelfarsaNar
14-I
0 Lea< 3