1982, 06-11 Permit: 82A-4887 PoolPLAN NUMBER
APPLICATIIN/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
LOT BLOCK` SUBDIVISICN
►'�%-�I�'�� tib ..
LEGAL DESCRIPTION — SEE ATTACHED
OWN
ADDRESS '
& 1 1125 z-& 1
CONTR4CTOR
c ;-rte P�
4. ADDIESS I
ill9 P1ti
1 M(fie-a\
PARCEL NUMBER/S 04.442, — �70
PHONE
ZIP
PIION
Actual Set Backs in Feet
North !South
Size of Parcel
160 i�i�?
ZjP
Type Const.
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
PHONE
ZIP
TO
t -NEW ❑ ALT. ❑ AD'N. ❑ RPL. �❑,jMVE.
❑ BLD! ❑ PLMB. 0 MECH. 0 M.H. ErPOOL
0 OTHER
Valuation
East
Zone C
(West
liassification
Oecupp/ancy
❑Yes
Sprinklered
�{jl 1/ ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage
Main Floor 1 Upper Floors Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not P6q'
DESCRIB WORK
8. flt4Mi1\1% (Ifr
VALUATION SOURCE GAS ELECTRIC WATER
/��
9. `"'1/
UTILITIES
Enum. Dist.
Location (Area)
SEWER
Ownership
Public ❑ Private
USE CODE
I hereby certify that 1 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 • aws and ordinances governing this
type of work will be complied with whether specified herein or not. The grant) g of a permit does of presume
to give authority to violate or cancel the provisions of any other state or local .w regulating cons lection or the
performance of construction. EE REVERSE SIDE FOR REQUIRED INS ONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env!HLalth
Planning
///
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SIGNATURE OF APPLI
SPECIAL CONDITIONS:
FEES COLLECTED
Single $
Building
Plumbing
ech.
Plan Check
SEPA
Mobile Home
PERMIT IS NONTRANSFERABLE
Other (Specify)
TOTAL $ , l
PERMIT NUMBER
-4E 'r
02* *2500
*2500
*25006
*000
441,72
'06-01-82
g 6.479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
06 'ilii 22
488.72 *25,00°
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
SEWAGE SYSTEM VERIFICATION
THIS FORT SHOULD BE COWLEIEL WHEN THERE IS NO RECORD OF EXISTING
SEWAGE SYST Me
IN ORDER TO PROCESS YOUR BUILDING PROJECT, THE FOLLOWING INFORMATION
;EDS TO DE VERIFIED:
ADDRESS
dor ,€
AGE OF HOUSE PGE OF SYSTEM
TYPE OF SYSTEI INSTAI I FD AT THIS PROPERTY.Se�, ,cra--k =
WAS THE SYSTEM LOCATION VERIFIED BY VISUAL OBSERVATION BY YMO
LOCATION OF THE SYSTEM (PLEASE MAKE DRAWING SHOWING LOT) HOU , TANK,
LRAINFIELD, iTFIER STRUCTURES, ETC.)
IS
REIK4RKS: 4 /.,
a cA,44--- of 4I o
0
N6RTfl
41141ex;ShI bvi...-74,L<E4-
THIS INFORMA ION IS PROVIDED TO 111E BEST OF MY KNOWLEDGE. 4^-// F'�'�
SIGNED: /C .i SK s/25/5 ��.
. . (FUME)
4
MUAIL MIS FORA TO:
10/M
ENYIRJ,^Yt HTAL HEALTH, WEST Biz COLLEGE, ROOM 201
SPOKANE, WASHINGTON Trca (PHONE 5094155-624n)
•