1980, 06-06 Permit G80-5267 Pool HtrPLAN NUMBER
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APPLIGS,`)N/ rtKMI I
POKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
1.
2.
3.
JOB ADDRESS
LOT
OWNER
BLOCK
ADDRESS
CONTRACT
(\) (o.O P1(LGc v' Qt) �.
SUBDIVISION
4' ADDRESSf s
es
DESIGNER
s'PHONE
ci2.N -1 t50
ZIP
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Actual Set Backs in Feet
North 'South (East 'West
Size of Parcel
Zone Classification
ZIP
t Th :
PHONE
Type Const.
Valuation
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
5' ADDRESS
ZI P
Main Floor
Upper Floors
Garage Area
Storage
6.
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
IA"
NEW ❑ ALT. ❑ D'N. ❑ RPL. ❑ MVE.
❑ BLD. P,LMB. MECH. ❑ M.H. ❑ POOL
DESCRIBE WORI�r��,
8. AM(=> Cktkt61k.�2-
VALUATION GAS ELECTRIC
9.
SOURCE
OF
UTILITIES
WATER
❑ OTHER
SEWER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist, 'Location (Area)
Ownership
Public ❑ Private ❑
USE CODE
Req'd.
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 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 r 3 _ b SIGNATURE OF APPLICA (.7?'
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
i 1 P►,
P Kp.tc n
CS'Qif
N OC3) 090 itDe
l l
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PS'
04*
*1500
*1500 tn
5266s
06-03-80
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
c
L
L
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
0'6-03 8'0 526,75
DATE ISSUED PERMIT NO.
*15,00°H
TOTAL