1984, 04-02 Permit: 84A-2826 PoolPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY DEPARTMENT OF BUILDING & SAFETY •
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBE-RED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1.
LOT '1
2. pg
PARCEL NO.
33582 -0506
BLOCK
4
SUBDIVISION
A LO H -A, A
OWNER
3.ita't1`r e (fU m
MAILING ADDRES
PHONE
PHONE
LEGAL DESCRIPTION:
ZIP
Actual Se Backs in Feet to• :
North If !South (La' 1East Z i
West
ZI
4.
5.
C9,1)1ACI:)(R?,E,t;s i IJ c1.
ADDRESS
•
DESIGNER
ADDRESS
LICENSE EXPIRES
3/10 Pru lt, j a OKAN5
7O7
Size of Parcel 1 Zone Classification
TypeM
Nl ncy
1
Residential
Commercial 0
Spr nklered
❑Yes ❑No ❑Req'd.
PHONE
New Const. Valuation
Remode ed Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE >3.NEW 0 ALT. 0 AD' N. 0 RPL. ❑ MVE.
7. OF
0 BLD. ❑ PLMB. 0 MECH. ❑ M.H. POOL
WORK
0 OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
Required Yes❑ No❑
Received Yes No❑
Number
8. DESCRIBE WORK � \JAL -
l rn 'co
Shorelines/Flood Hazard
Yes❑ NotApplic. ❑
Plans Requ'red ❑
Received 0
VALUATION
9.
SOURCE
F
UTILITIES
GAS
ELECTRIC
WATE
PUBLIC
PRIVATE ❑
SEWAGE
SEPTIC 0
SEWER
Ownership
Public ❑ Private 0
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
OWNER OR AGENT
DATECATION
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
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
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
t W V
TOTAL $ —
PERMIT NUMBER
g4A
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS
����BECOMES A PERMIT.
DATE'ISSUEDO 2 8 4
PERMIT? c 2' 6 z * 2 5. O OTO AL
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