1983, 05-25 Permit: 83A-4525 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
1.
2.
STREET ADDRESS
l ob'
LOT
114
BLACK
SUBDIVISION 1
PAIK(Ai 010 -
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3.
MA UN? AD R ►V114
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PHONE
PARCEL NO.
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LEGAL DESCRIPTION:
CO CTR
4.
ADDRESS
LICENSE EXPIRES
DESIGNER
5.
ADDRESS
CHANGE OF USE FROM
6.
PHONE
ZIP
PHONE
ZIP
TO
TYPE .-lINEW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
7. OF 0 OTHER
WORK ❑ BLD. ❑ PLMB. 0 MECH. 0 M.H. 9 -POOL
DESCRIBE 10FIK
SOURCE
UTILLIITIES
VALUATION
9. 1, °('---)
Actual Set Backs in Feet to:
North 'South
SIT orcel
TypeY ' y
East
West 10
�CJ
Zone Classification
Residential
Commercial C
1°1-'292'.
New Const. Valuation
Spr'nklered
CYes 0No CReq 'd.
Remode ed Valuation
Main Floor
GAS
ELECTRIC
WATER
PUBLIC
PRIVATE0
SEWAGE
SEPTIC
SEWER O
Cover Deck
No. Baths
Certifi. of Exempt.
or Variance
Upper Floors
Uncv. Deck
No. Floors
Garage/Storage
Total Bldg. Floor Area
Required
Received
Shorelines/Flood Hazard
Yes NotApplic. ❑
Ownership
Public 0 Private,
G eenhouse
Fin. Basement
No. Fin. Rooms
YesE NoC
YesE Nor'
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 IDE FOR REQUIRED INSPECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGEDATE . j -y•
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE EEVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
72
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Unfin. Basement
No. Dwellings
Number
Plans Required C
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify) t f
TOTAL $
PERMIT NUMBER
02* *2500
*2500
A *Q00 8
45252
05-25-83
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE1SSUE� 5
PERMI. 2
T NO " Z
*25,00.AL
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