1981, 03-31 Permit: 81A-2721 Poolg7/3A1
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
�.<_ /4%//..
LOT
2.
OW ER ,,/
ADDRESS // �� //f,F��]]��)
/k'7/l, l../.�/�-�C./iT`F�/r
CONTRACTOR
C A124 --Wit
4.
ADDRESS
71( // / ? �,'Y Q-�i` , iC1.:V'/4is1/✓i� �.
DESIGNER
BLOCK
//:
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
5.
PHONE
!/,< .x =moi /��`•
PARCEL NUMBER/S 64434'2 - 'ie) 7
107 ? .:i11 { A ffyR4>(!
ZIP
PHONE
Actual Set Backs in Feet
North ie,
South -
;
East /t
Size of Parcel
ZIP
c7 /;CdC.
Type Const.
Occupancy
'West v�
Zone Classificatipon p
t1(;(,�y04//( ,u/11-� 4Y -
Sprinklered
❑Yes No El Req'd.
PHONE
ADDRESS
ZIP
V luation
Main Floor
Building Area in Sq. Ft.
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
7.
TYPE
OF
WORK
C.1 NEW
❑ BLD.
❑ ALT.
O PLMB.
O AD'N.
O MECH.
❑ RPL.
❑ M.H.
❑ MVE.
POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
ESCRIBE WORK
8.
VALUATION
9OD7)
SOURCE GAS
OF
UTILITIES
ELECTRIC
WATER
SEWER
Enum. Dist.
Ownership
Public ❑ Private
ILocation (Area)
USE CODE
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 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 INSPECTIONS %/
DATE OF APPLICATION A.1—(1 SIGNATURE OF APPLICANT `
SPECIAL APPROVALS
NAME DATE
Env alth
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bt1i,IdingTec nicia
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
SNI/"WA.
P4�(44
t
Other (Specify) `2-"'
TOTAL
PERMIT NUMBER
02* *2500
*2E00 V,
*25006
A *000
228:02
03-1 1 x-81
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 5; ,1.3it1 if
DATE ISSUED
24a1: *25002
PERMIT NO. TOTAL
rN AVE
k'
/ �yP
f#`"
EX/-5/7A/a.
REs/a6UCL
45-