1983, 07-27 Permit: 83A-7020 PoolPLAN NUMBER APPLICATION PERMIT PERMIT^UMBT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY ��` - �Z��
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
sTR . 11:2-14-
1 � I tet' ,. _ `r, PARCEL NO. r5 �
1. E � T�T�
2 LOT IqC S BDIVI$ION LEGAL DESCRIPTION: W I I Lo --r
21
OWNER P O E PHONE
3. �I - 4-
MAIy,NG AD�Fj� i � � �.y� Actual Set Backs in Feet to:
o- ` ' �- � � North (South (East
CONT T
LICENSE EXPIRES
PHONE
Residential'
4!�jj
I nassificatipn I
1&5
Commercial ❑
ADDRESS
ZIPTypy.
ncy
Sprinklered
❑Yes ❑No ❑Req'd.
1.
DESIGNER
PHONE
New Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
*2
5.
,GGY
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 21NEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF ❑OTHER
ZPPOOL
/1
Certifi.ofExempt.
Required
Yes❑ No❑
Number
WORK ❑ BLD. ❑ PLMB. ❑ MECH. ❑ M. H.
or Variance
Received
Yes❑ No❑
DESCRIBEIWO K I
8
Shorelines/ Flood Hazard
Plans Required ❑
W ��rlroa,Yes❑
Not Applic. ❑
Received ❑
VT ATION
9• OCA
SOURCE
AS
ELECTRIC
WAT R
SEWAG
SEWER
Ownership
FEES COLLECTED
I
UTILOITIES
PRIVATE ❑
❑
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-
Building
thority to violate or cancel the provisions of any other staM or local law regulating construction or the performance
of construction. SEE REVEMM SIU FOR REQUIREDOOPECTIONS
Plumbing
!
SIGNATURE OFAPPLICATIONS
OWNER OR AGENT DATE
Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Plan Check
Env. Health
SEPA
Planning
Modular/
MFG. Home
Prevent.
Engineer
Utilities
SEPA
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Building -7 IN 180 DAYS
Other (Specify)
TOTAL $
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
% 7 p '7 (� n 0 o
DATE(� YSSUELi
D I PERMI1 J. 2' G
* 2 5.0 0 �O-O�AL
CL
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C.2
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