1981, 11-13 Permit: 81B-1803 Special InspectionAPPLICATION /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
1.
2.
3.
JOB ADDRESS
I9>C?
LOT BLOCK SUBDrVISION
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S
OWNER
ADD ESS �j
CONTRACt R Pie--.
4' ADDRESS
PHONE
Z P
0cy�
Actual Set Backs in Feet
North 'South East (West
PHONE
Size of Parcel Zone Classification
ZI P
Type Const.
Occupancy Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
Building Area in Sq. Ft.
ZI P
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
8.
9.
DESCRIBE WORK II _
t°f'61\� IN rte 1I°
VALUATION
SOURCE
OF
UTILITIES
GAS
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Not Req'd.
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private ❑
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 // / )_ 3 /i SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
1
1) .7-7�;
/3")-7'7 S
7Q5 A141 c _ L
7 L -.t,ia 7TH M/: f (& re—rW oc ,4t
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIMIT.N�UMBER t ,�
G"" 1 T? _7
2*
* 8.00
* 800 n
180,22
1 1-1 3 -81
g 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11;'-r131—
DATE ISSUED
18a'3Z8,OOa0
PERMIT NO. TOTAL
d
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