1980, 04-18 Permit: 80-3689 PoolPLAN NUMBER
-41-10
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
1. t idb 4 3 44re 4 ,
LOT BLOCK SUBDI I ION
VNER
_..d'*
PHONE
9z -3676
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
,DA R C J E S TA r,55
ADDRESS
C,iLIc- - 4L
CONTRACTOR
4.
A RESS
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
❑ NEW
O BLD.
O ALT.
❑ PLMB.
ZI P
99=2 G�
PHONE
ZIP
PHONE
ZIP
TO
❑ AD'N.
❑ MECH.
❑ RPL. ❑ MVE.
O M.H. yy POOL
0 OTHER
Actual Set Backs in Feet r
North 3 t) / 'south j 61,') East ‘.."3-1-3- (West _� 3
Parcel
Type Const.
i
4
Zone Classification
Occupancy
Valuation
Main Floor
Upper Floors
ISprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
.S"i
Garage Area Storage
Area of Decks
Finished Basement
No. Baths No. Stories
Unfin_ Basement
001115
No. of Dwellings
CERTIFICATE
of EXEMPTION
D SCRIBE WORK
8.
"VALUATION TION SOURCE GAS • ►ELECTRIC SEWER
OF
9.,6VDC)o.� UTILITIES
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. Al( 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 authority 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 INSPECTIO
Enum. Dist.
Req'd. ec'd.
Location (Area)
®
Ownership
Public ❑ Private a
USE CODE
DATE OF APPLICATION 4 SIO SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
SPECIAL CONDITIONS:
Env. Health
N/1' /c t� 0. -20 -11)14, -CI
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
uilding ech cian
i
1 aVYI .I.C.�YI
J'[EUrse° 5, TE PeAit! 4 T, CJr6J
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Pvv.,
Building
PlumbingL
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$
PERfIT NUMz3ER
go -3bg9
02* I*25.00
(*25.00
r* 25.00
E *0.00
368.88
p4_18-'80
g 6/479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
014=11'8"-B'0 5'68.90 *25.0.11PI- -
DATE ISSUED
PERMIT NO. TOTAL
lit