1983, 03-23 Permit: 83A-2157 PoolPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
SEPA
PERMIT NUMBER
r r.
Modular/
MFG. Home >,
iZ
O
Other (Specify)
W
J
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES APERMIT.
DATE(�ED2 3 -8 " J PERMIAJ. 5. 7 z
* 2 5.0 0 �olrAL
U.
No. Baths
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
No. Fin. Rooms
No. Dwellings
STREET ADDRESS
PARCEL NO.
1.
LE p 12 --`t T.a
2 q -'—J ` — ..
Certifi. of Exempt.
LOT
I BLOCK
SUBDIVISION
LEGAL DESCRIPTION:
Received Yes❑ No❑
2.:5--.1-
Z'j
tcv�o vKo
Plans Required ❑
IL�
�i l t 11 r'1'1. ru G,i�7pG. mit 7
Yes ❑ Not Applic. ❑
Received ❑
OWNER
7F=
PHONE
I WATERSEWAGLEf�
3.
3�w � � .�
�ke� Y
` o
UTILLIITIES
PRIVATE ❑
MAILING ADDRESS
Public ❑ Private
ZIP
Actual Set Backs in Feet to:
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
F-- 1 \ "
` ' �
� .
North South 1_';i East West
1 '
of construction. SEE RE IDE FOR REQUIRED INSPECTIONS
CS;)NTRACTOR
LICENSE EXPIRES
PHONE
Size of ParcelZoneClassification
OWNER OR AGENT DATE'C
Residential
4.
^�
t • �tkj N 1/
PRELIM. FINAL DATE
5r -L{ 15 -74,�
X 13t>
O a .CJ
Commercial ❑
ADDRESS
ZIP
Ty l!�QDnst.
Occupancy
Sprinklered
P.. U.
474..14
A%
❑Yes ❑No
❑Req'd.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
-7
5.
ADDRESS
ZIP
Main FloorUpper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
SEPA
PERMIT NUMBER
r r.
Modular/
MFG. Home >,
iZ
O
Other (Specify)
W
J
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES APERMIT.
DATE(�ED2 3 -8 " J PERMIAJ. 5. 7 z
* 2 5.0 0 �olrAL
U.
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
TYPE �pe—W El ALT. El AD' N. ❑RPL.OF ❑/MVE.
%. ❑OTHER
Certifi. of Exempt.
Required Yes❑ Nov,Number
WORK El BLD. ElPLMB. ❑ MECH. ElM.H. (SPOOL
or Variance
Received Yes❑ No❑
DESCRIBEWORK
8
Shorelines/ Flood Hazard
Plans Required ❑
IL�
�i l t 11 r'1'1. ru G,i�7pG. mit 7
Yes ❑ Not Applic. ❑
Received ❑
VALUATION I
9
SOURCE
GAS
ELECTRIC
I WATERSEWAGLEf�
Ownership
FEES COLLECTED
` o
UTILLIITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private
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 au-
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE RE IDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATIO
��
OWNER OR AGENT DATE'C
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
SEPA
PERMIT NUMBER
r r.
Modular/
MFG. Home >,
iZ
O
Other (Specify)
W
J
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES APERMIT.
DATE(�ED2 3 -8 " J PERMIAJ. 5. 7 z
* 2 5.0 0 �olrAL
U.