1983, 07-08 Permit: 83A-6326 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
STREETADDRESS PARCEL NO.
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LOT BLOCK SUBDIVISION LEGAL DESCRIPTION: L-c-rS r,'r4 1,-o'1,2LO
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OWNER IPHONE I PHONE
3. rlilr�E = rflM
MAILING ADDRESS
C. 1 %U %'2 7_� 14
CONTRACTOR
ADDRESS
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
TO
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ZIP
LICENSE EXPIRES I PHONE
ZIP
CCAJ.,
PHONE
ZIP
7
TYPE QeNEW ❑ ALT. ❑ AD'N. ❑ RPL. 11MVE. El OTHER
Actual Set Backs in Feet to:
Certifi. of Exempt.
Required Yes❑ Noy
North
South `JG)
East West
t
Size of Parcel
DESCRIBE WORK t
Shorelines/ Flood Hazard
Zone Classification
Residential
t Co )(
130
VALUATION
�.' 1
Commercial ❑
Type qppst.
Occupancy
Sprinklered
Ownership /
N
rn Z
Dyes ❑No
❑Req'd.
Nw Const. Valuation
__[
Remodeled Valuation
Total Bldg. Floor Area
�C�t 5
Public ❑ Private P
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
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Uncv. Deck
SIGNATURE OF r APPLICATION
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. Rr POOL
Certifi. of Exempt.
Required Yes❑ Noy
I Number
or Variance
Received Yes El No❑
DESCRIBE WORK t
Shorelines/ Flood Hazard
Plans Required 138•
;,r, % M r,_ 1114 C, i�r",t,L LI(OX 3 Z�
Yes 1-1 Not Applic. ❑
Received ❑
VALUATION
SOURCE
GAS
ELECTRIC
WATER
SEPWACG je
Ownership /
FEES COLLECTED
9• CI A';
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private P
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-
Building
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
Plumbing
SIGNATURE OF r APPLICATION
OWNER OR AGENT DATE �f'�✓
Mech.
SPECIAL APPROVALS
PRELIM. FINAL D.
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify) 2 ` �
TOTAL $'�
PERMIT NUMBER
tr 00
2.
c 0y
Q,—S
C 4
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. L
DATEU6E� 8 _ PERMIAN. 2.6 z
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