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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 w J 6 AlinelfarsaNar 14-I 0 Lea< 3