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