1983, 06-23 Permit: 83A-5695 PoolPLAN NUMBER
11111 APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASIf1NGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
PARCEL NO. 6r...
��O
LOT
2.
LOCI(
SUBDIVISION
3. MA NG I DD� / �it.c.1,
CONTR1CTO9
4. A �C•�LJ �` C'_t'.IIif
im, KJ
DESIGNER
5.
PHONE
LICENSE EXPIRES
PHONE
LEGAL ON: DESCRIPTIb, �i or 6 1 I or
Glc, r 4-3 '
Actual Set Backs in Feet to:
North 7) 'South East I Cv
Size of Par9;11 Ine Cla iii ti
Typz irl.
New Const. Valuation
0
West 1 O
Residential.
Commercial ❑
Spr'nklered
❑Yes 0 N Reg 'd.
Remodeled Valuation
Total Bldg. Floor Area
ADDRESS
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
6.
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE 14VEW
7. OF
WORK ❑ BLD.
E ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
❑ OTHER
❑ PLMB. ❑ MECH. ❑ M.H. .P�ROOL
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes Norl
Number
8. DES�IBQW RI kW '\t I c7L.
VALUATION
9. ,0‘3.0F
SOURCE
UTILITIES
GAS
Shorelines/Flood Hazard
Yes❑ Not Applic. 0
Plans Required 0
Recelved 0
ELECTRIC
WATER -
PUBLIC.) '
PRIVATE 0
SEWAGE
SEPTIC/
SEWER 0
Ownership
Public 0 Private IV
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
reverse side, and know the swipe to be true and correct. All provisions of laws and ordinances governing this type of
work will be complied with/Whether specified herein or no The granting of a permit does not presume to give au-
thority to violate or cance the •rovisions of any other st- 1_ or local law regulating construction or the performance
of construction. SEE RE ER SIDE FOR R3!iT11' ED SPECTIONS
SIGNATURE OF
OWNER OR AGENT
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
APPLICATION
SPECIAL C6NDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify) 2-5
TOTAL $
PER
c-zf M B5R,
0 2
*2500
*25.006
*000
69,4f.
)6,-23-83
'6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED 2 3.- 8
PERMIT NO. 6 9. 5 z
*2 5.0 4o°ki
1 U tUti rttimi i iu
v.s
i l
(� & .) '1'1ti/ 6- t. Address_______________________ __Phone No.___
- _ S C' a-- i j
ed Site . / ..'/' ' ( .l .1. - t:.� - — C1. - ._`.._-fit
'J /
C..----�---C...' _ _.Is basement for buildinghlanned?____ 4�'�
,� `
city
ISA field
aiCapacity__
Building Capacity_________ ___._C___Camp ------ —
, e ..< (City, Well, Spring). Drywell_._-T_ -- —
LQ12Q-_gals. Style of tank_
Absorption Pit
Leach Bed ,
location of: Proposed house. sggAtiftrikark, A
I, 'well. garage and other outYbu.ildings.
. vswaViMorieltY.
asy heavy slope or
nt topographic deta'��.
Soo
C c'
f--\
i 1
)10, f yo, 11-3
t
S
n Date___ / t
•
For Spokane County Health Department