1982, 06-30 Permit: 82A-5575 PoolPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDeNG CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
1)1 APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
2.
JJB ADDRESS
ti •
LOT
BLOCK
SUBDII`V/I
I! IN ��6i 0\11 ri,Aj
3.
4.
OWNER
ADdRESS E
CONT ,P R CT
LEGAL DESCRIPTION — SEE ATTACHED
54E-364-1
.
PHONE
PARCEL NUMBER/S L `
-,1.`' 150' c 1,0-15 9 4i ti
Actual S t Backs in Feet
North 'South
Size:IG)ceA
East (West
ADDRESS
ZIP
Type)Const.
cupancy
•2�
pZlassification
jPFF\ LC
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5 ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
NEW ❑ ALT. ❑ AD N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. L7 POOL
DESCRI i WORK
8. IM
9.
VALUATION SOURCE
OF
UTILITIES
GAS
LECTRIC
WATER
Area of Decks
Finished Basement
Unfin. Basement
❑ OTHER
SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private
SE CODE
Req'd.
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. SEE REVERSE SIDE FOR REQUIRED 1/4S S
DATE OF APPLICATION
SPECIAL APPROV1LS
NAME DATE
vt�jrealth
i ‘/3Q
anning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
IGNATURE OF APPLICANT
SPECI • L CONDITIONS:
PERMIT IS NONTRANSFERABLE
Rec'd.
Notq'd.
FEES COLLECTED
Single $
Building
Plumbing
AR�ch.
Plan Check
SEPA
Mobile Home
Ot er (Specify) 2K
TOTAL $ 6—
PERMIT N' LMBER
I
02*
5[1612
*2500
0'6-2882
647'9,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 6,5' 2,
557.55 **25.00 a1 -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
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