1983, 04-12 Permit: 83A-2872 PoolPLAN NUMBER
e/
APPLICATION/PERMIT PERMITNUMBER
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY�-
NORTH 811 JEFFERSON/ SPOKANE, V .SHi ioGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STR ET ADDRESS
PARCEL NO.
LOT
BLOCK
I SUBDIVISION
LEGAL DESCRIPTION:
Y�O
OW EE
PHONE
HON
3.
ik-
MA INGIA DRESS
Actual Set
Backs in Feet to:
1 �� +
Z
�L7
North
South East West
CONT A TgR
LICENSE EXPIRES
PHONE
Size of Patcel
Zone Classification
Residential
4.
Commercial El
ADDRES9
ZIP
Type Cogs* .;
Occupancy
Sprinklered
t J1iV
";
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
New Const. Valuation .
Remodeled Valuation
Total Bldg. Floor Area
5.
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
6.
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
TYPE NEW
1:1 ALT. 11 AD'N. El RPL. ❑ MYE.
7.
OF
❑ OTHER
Certifi.ofExempt.
Required Yes No❑
Number
l
WORK ❑BLD. ❑ PLMB. ❑ MECH. ❑ M.H. POOL
or Variance
Received Yes Nor,
8'
DESCRIBE`�VORK
I Q y'j
Shorelines/ Flood Hazard
Plans Required ❑
- I I
N�� I C`�t1
YeSE Not Applic. 11
Received ❑
VALUAJON
SOURCE
OF
GAS
ELECTRIC
WATER
PUBLIC 0
I SEWAGE/
SEPTIC -{'I
Ownership
FEES COLLECTED
9• IC>.)�C� UTILITIES 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 REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION 2 3 —
OWNER OR AGENT TE
li
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM, 'NAL DATE
Env. Health i
Planning
150111107
Plans i i i I PERMIT IS NONTRANSFERABLE
Exam. I PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building -4-/ 1 IN 180 DAYS
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
r00 -
TOTAL $
WHEN MACHINE VALIDATED IN THIS S
THIS BECOMES A PERMIT.
DATETSSUEDl Z- 8 3 PERMIT 7' 2 z * 2 5. 0 0 fO�AL
CL
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W
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