1984, 02-28 Permit: 84A-1661 PoolPLAN NUMBER I APPLICATION /PERMIT
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
STREET ADDRESS/g PARCEL NO.
r CJ �� V
2. LOT I BLOCK I SUBDIVISION LEGAL DESCRIPTION:
O SNE5�
PHONE
P�jO�IE�
`} c
2- 7t
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to: +
I
Planning
North South East
West
CONT CtTAR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential ❑
V�j
Engineer
Commercial ❑
4.
SEPA
Plans
A RESSI�� ; `S
V019❑Yes
ZIP
Type Const. Occupancy
Exam.
Sprinklered
❑No ❑Req'd.
DESIGNER
P ON
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
TYPE XJVEW ❑ALT. El AD' N. El RPL. ❑ MVE.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
7. El OTHER
OF
WORK 11 BLD. ❑ PLMB. 1-1 MECH. El M.H. BOOL
Certifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes ❑ No ❑
DESCRIBE WORK
8 PXi&
Shorelines/ Flood Hazard
Plans Required ❑
Yes❑ NotApplic. ❑
Received ❑
VAL ATION
9
SOURCE
GAS
ELECTRIC
WATER
SEWAGESEPTIC 0
Ownership
FEES COLLECTED
•�/
UTILLIITIES
PRIVLICATE E 11
SEWER ❑
Public ❑ Private ❑
1 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 au-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE:�IELE FO EOUIRED INSPECTIONS
Plumbing
SIGNATURE OF y
OWNER OR AGENT4�
DATECATION .21 U
Mach.
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
2- 7t
.moi,
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
PERMIT NUMByE"R
A — i tom&
Other(Specify)
WLI-
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
s.
DATgiSgukD U U 'i PERMITiNA. ! 0
� n FI n rTiOTiAL
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