1982, 04-27 Permit: 82A-3252 Single Wide MHPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — 1311ILDI!■!G CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
1.
LOT
JOB ADDRESS
E.. 170(. 4
LEGAL DESCRIPTION — SEE ATTACHED
BLOCK
SUBDIVISION
2.
OWNER
3. Q •ca- T Aoctims
ADDRESS
Be›A '14r2_ & tt
PHONE
PARCEL NUMBER /Se, • (10' (?F N. t tk.j
t 7 CCni.6St+ll} ADQ -re aeocvniAc.a.6
S2 -C73 t
ZI P
Qctbt (�
Actual Set Backs in Feet
North r� C (South
East 5 (West
CONTRACTOR
4 ADDRESS
PHONE
Size of Parcel
Zone Classification
416a -I C.-i .c_L.:. vcre .tA
ZIP
DESIGNER
5. ADDRESS
PHONE
Type Const.
Occupancy
Ia
Sprinklered
Oyes ❑No ❑ Req'd.
ValE►ation
413W 0, CC-6
Building Area in Sq. Ft.
ZIP
Main Floor
CIPCJ
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
liNEW ❑ ALT. ❑ AD'N. D PL.
❑ BLD. ❑ PLMB. ❑ MECH. M.H.
❑ MVE,
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not fi'd.
DESCRIBE WORK
8. Osiskztc L %tQE,
VALUATION
�Jir2 ,mss
Enum, Dist.
MOLb%c F Porn G 14 yG 76
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
`. �c'prt C
Location (Area)
I1
Ownership
Public ❑ Private flf7
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 �Z SIGNATURE OF APPLICANTa Ci�2lt
SPECIAL APPROVALS
NAME DATE
Env /yleal
Planning
3
Fire Marshall
Co. Engineer
42 / V17
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home 4
Other (Specify)
TOTAL
PERMIT NUMB_R
07* *5000
*50.00 UD
*50,008
A *0,00
323.12
04 -2782
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
014 71:1:81
DATE ISSUED
3' 25, 2 z
PERMIT NO.
*5now. 4
TOTAL ��