1979, 09-18 Permit: 79-4162 Pool PLAN NUMBER APPLICATION/PERMIT
_6 PERMIT NUMBER
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
71— 9/6.z
NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675 DATE -- .c-/31- /y , / % 7,
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
02 * * 2500
JOB ADDRESS �!� LEGAL DESCRIPTION — SEE ATTACHED * 2 5 0 0
17)
LOT BLOCK SUBDIVISION PARCEL NUMBER/S � l
2. .3 3 ililey tilC di411 4d , 414 - 3 `` * 25006
PH NE _ �/(/ _ _ e L�l� l d9/.-1-5 * S
OWNER $ 4 F? �-*c4 !;S- ,j if A.0 -3 4-30‹ i !: :, vo ,At.op E 0 0
3. � 6.0 p
ADDR SS ZIP Required Set Backs in Feet r 4 0 1.2
/,, O / t North g 'south .;.--4,1 ` East ,Jcr J West �() O 9 1 4—7.9
CONTRACTOR PHONE Size of Parcel Zone Classification p #
..,4-.'",77 I r t / L.c;1..S .L- .4 c.'- Iv, -w I / 64-„ G42.4... ta ,z�J.0u g 6 4 7 9,
4' ADDRESS^ 1- ZIP
/ (� Type Const. Occupancy Sprinklered
ISO 9 //,-I,�e),s . ? / ! / J Eves ❑No ❑ Req'd.
DESIGNER J PHONE Valuation Building Area in Sq. Ft.
/. 7 ,.4k ( :.~ As v c. - VE r1 _-;
5. ADDRESS • ZI , , y,. OWL Area Basement Area Garage Area Storage —
CHANGE OF USE FROM TO Split Entry , SpJit Levi ,, Rapther
6. /.
No. Baths No. Floors No. Rooms Rec. Room
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7. OF �{1 ❑ OTHER Req'd. Recd. Not Req'd.
WORK ❑ BLD. ❑ PLMB. ❑ MECH: ❑ M.H. /` POOL CERTIFICATE
of EXEMPTION
DES.5RIBE WORK , J j7 _ FEES COLLECTED
8. e-,, .( 41 L,./i7 L. �GJ .,i , ,57. s7 (( 1 Z� C:
DATION Source
of GASP ELECTRIC WATER SEWER
g, 7$ T
G)C Utilities Single $
—
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 Building
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 regula ' g construction or the
performance of construction. F---- Plumbing
_ .,6"1,41r-,-:, .--c'T'�--.
DATE `C'1 ' "1-7./ 7 SIGNATURE / , Mech.
SPECIAL APPROVALS SPECI CONDITIONS: `
DEPT. REQ'D. REC'D. Plan Check
Env.Health a1 -e
%e -7/ /7 l ® L ' 'nF /3 SEPA o--
(D
c
tU
Planning
— u�
a
Fire Marshall Mlle Home �
!!,,
Co. Engineer Other (Specify)
Utilities , c9��
TOTAL $ q,S
Zone Clearance
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
SEPA Checklist n 1 Q — / _
DATE OFFICIAL 0 '1 8 7 9 41 6, 2 z * 2 5, 0 0 2 F�
APPROVED FOR ISSUANCE _
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