1984, 04-18 Permit: 84A-3455 PoolPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
PARCEL NO.
Z.671-4 ' _ 2,go -7
2.
3.
LOT
OWNER
BLOCK
SUBDIVISION
—3/4v >QDDi ioN
MINOR .
PHONE
PHONE
LEGAL DESCRIPTION:
MAILING ADDRESS
ZIP
Actual Set Backs in Feet to:
North lee, i I South East
—I
West
4.
5.
CONTRACTOR
06}1Z) m fid
LICENSE EXPIRES
PHONE
'2/5 -52799
Size of Parcel 1 Zone Classification
Residential
Commerci E
ADDRESS
0161 N, Pits 5
DESIGNER
Type r,.o
PHONE
Occpincy
NRemodeled Valuation
Sprinklered
❑Yes ❑No ❑Req'd.
New nst. Valuation
ADDRESS
ZIP
CC
a
Main Floor Upper Floors
Total Bldg. Floor Area
Garage/Storage I Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Untin. Basement
TYPE KNEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7• OF
WORK ❑ BLD. ❑ PLMB. ❑ MECH. E M.H. APOOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No
Received Yes❑ Non
Number
8.
DESCRIBE WORK
14' i4- z skit/114,01i Nkp PoUt-
Shorelines/Flood Hazard
Yes❑ Not Applic. ❑
Plans Required ❑
Received ❑
VALUATION
9.
SOURCE
UTILLIITIES
GAS
ELECTRIC
WATER
PUBLIC
EK $.
SEWAGE
SEPTIC
SEWS ❑
Ownership
Public ❑ Private X.
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
reverse side, and know the a to be true and correct. All provisions of laws and ordinances governing this type of
work will be complied with-wh ther specifie "herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the rovisions of ny other state or local law regulating construction or the performance
of construction. SEE REV RS SIDE FOR EQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT '1�l/t-� APPLICATION Zit/
DATE
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
ih 7
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) 1 al • CCS
Pro li
TOTAL $
?,2 L-.�-
PERMIT NUMBER
014-t341
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATEYSSUED1 131 _ " 4
PERMIT -4 5. 5 z * 1 0 2. 0 O TO AL