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1982, 03-31 Permit: 82A-2356 PoolPLAN NUMBER APPLICATION/PERMIT SPOKANE COUNTY - BUIJ.DIN(,'- CODES DEPARTMENT NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675 APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES JOB AD RESS BD TO— LOTBLO � UBD VISION 2. 1 1 1,65 AQPI-r. 3. 4. 5. OWNS i LEGAL DESCRIPTION - SEE ATTACHED PARCEL NUMBER/S 27-I4. it ,t J ( nJ ADD SS j 1_t4 CONTR CT R r ADTESS11Nery DESIGNER ZIP PHO E t52 PH 6111 NE Actual Set Backs in Feet North 17 (South Size of Parcel East JI ? 'West Tygonst. Occupancy Zone CI ssification Si S rinklered ❑Yes ❑No ❑ Req'd. Valuation 96 640 Building Area in Sq. Ft. 36, ADDRESS ZIP Main Floor Upper Floors Garage Area Storage CHANGE OF USE FROM 6. TO Area of Decks Finished Basement Unfin. Basement TYPE 7. OF WORK 8. W ❑ ALT. ❑ AD'N. ❑ BLS). ❑ PLMB. ❑ MECH. DESCFirE WORK VALUATION SOURCE OF UTILITIES ❑ RPL. ❑ E. ❑ M.H.OL GAS ELECTRIC TE R ❑ OTHER SEWER No. Baths No. Stories CERTIFICATE of EXEMPTION Enum. Dist. l No. Rooms No. of Dwellings ILocation (Area) Ownership ,_.,// Public ❑ Private ttT USE CODE Req'd. I hereby certify that I have read and examined this application and have read the on reverse side, and know the same to be true and correct. All provisions of la type of work will be complied with whether specified herein or not. The gran to give authority to violate or cancel the provisions of any other state or loca performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPEC DATE OF APPLICATION 3 SPECIAL APPROVALS NAME DATE Fire Marshall Co. Engineer Utilities Plans Examiner SEPA Checklist 1 SIGNATURE OF APPLICA SP CIAL CONDITIONS: "NOTICE" provisions included d ordinances governing this a permit dies not presume egulating c• struction or the Recd. Not R d. FEES COLLECTED Single Building Plumbing PERMIT IS NONTRANSFERABLE PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE Plan Check SEPA Mobile Home $ Other (Specify) TOTAL $ 67Z-6 2.5 PERMIT•NUMBE$ AZA 235(p * 2500 * 2500 * 25006 A *C00 235,2 03-31-82 6,47 WHEN MACHINE VALIDATED IN THIS SPACE, THIS BECOMES A PERMIT. 013,' 8' 2 DATE ISSUED 235.62 PERMIT NO. *25.00a`� — TOTAL SEPNAGE SYSTEt VE1TI F I CAT ION THIS FOR1 SHOULD BE COMPLETED WHEN THERE IS NO RECORD OF EXISTING SEWAGE SYSTEMe IN ORDER TO PROCESS YOUR BUILDING PROJECT, THE FOLLOIING INFORP'ATION NEEDS TO BE VERIFIED: ADDRESS /-3 F-3 /r -6-74 AGE OF HOUSE c3 y1' AGE OF SYSTEM yAr TYPE OF SYSTEJ t INSTALLED AT THIS PROPERTY `� /' P r r C' TANK • WidS THE SYSTEM LOCATION VERIFIED BY VISUAL OBSERVATION BY YOU NO eatta�'^ LOCATION OF THE SYSTE t (PLEASE MAKE DRAWING SHOWING LOT, HOUSE, TANK, /t BRAINFIELD, OTHER STRUCTURES, ETC.) 3 Ao PL,F THIS INFORP: TI N IS P VIDED T i1 -IE BEST OF P4iy KNOWLEDGE. (;dAN1C (DATE) MAIL 1HHIS FORM TO: ENVIRONFENTAL HEALTH, WEST 11:91 COLLEGE, ROOM 2ni, SPOKANE, WASHINGTON gi_OI (PfioNE 91,514155-011) 10/;DO