1983, 07-21 Permit: 83A-6795 PoolPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASH IN99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREETADDRESS PARCEL NO.
,. f, ZZo Z`1 -1l'
LOT I BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. 'I- I 1 SKW V ► EA) Clc_e'�
SPECIAL APPROVALS
PRELIM. FINAL • DATE
nv. Health
Planning I It
Engineer
Utilities
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE 4
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify) 2_v
00L-
TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THISBECOMESA PERMIT.
DATE((��Y % T NS
UE[� �! PERMIO. �' S z * 2 5.O O AL
a
O
V
W
J
LL
OWNER1
PHONE
PHONE_
3.
MAILING ADDRESS
ZIP
Actual Sett Backs in Feet to:
ZO-Z7 +�
++
1 CQ
North 2_07 South 10') East
�L 1
d West 3. Z?
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
Residential B--
S A
ZO K 1 D1
Commercial ❑
4.
ADDRESS
ZIP
Type Con t.Occupancy
Sprinklered
Dyes ❑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. BathsNo.
Floors
No. Fin. Rooms
No. Dwellings
TYPE W El ALT. C]AD'N. El RPL. ElMVE.
7.
OF ❑OTHER
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M.H.�OpL
Certifi. of Exempt._F
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
8•
DESCRIBE WORK
Shorelines/ Flood Hazard
Plans Required ❑
-A ,
Yes Not Applic. ❑
Received ❑
VALUATION
SOOUF
GAS
ELECTRIC
PUBLIC O
SEPTIC E
Ownership
FEES COLLECTED
9
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private�'4
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
/�/ ��J APPLICATION
SIGNATURE OF lzz�s
OR AGENT !�G
7'7/"c3OWNER
v`
Mach.
SPECIAL APPROVALS
PRELIM. FINAL • DATE
nv. Health
Planning I It
Engineer
Utilities
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE 4
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify) 2_v
00L-
TOTAL $
PERMIT NUMBER
WHEN MACHINE VALIDATED IN THIS SPACE,
THISBECOMESA PERMIT.
DATE((��Y % T NS
UE[� �! PERMIO. �' S z * 2 5.O O AL
a
O
V
W
J
LL
atezz - 2 8 5 Yy %03
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