1981, 06-04 Permit: 81A-5439 AdditionPLAN NUMBED
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
❑ EW
3.
4.
JOB ADDr�ror, A��I
LOT BLOCK 1 SUBDIVISI N '' /�
OWNE1R
ADDRESS O�
�- Iql
CONTRACTOR I
t N
�OCV
ADDRESS 171 07 i
DESIGNER
rJ. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
ZIP
PHONE
ZIP
TO
LEGAL DESCRIPTION - SEE ATTACHED
PARCELNUMBER /S 17 I55 3 D7O7
L 1 ? / 1 FIT. j-rN • �r vA
. At-
Actual Set Backs in Feet
North 1South
Size of Parcel
ico
Type_ aonst.
Sprinklered
❑Yes ❑No ❑ Req'd.
Area of Decks
Storage
Finished Basement Unfin, Basement
No. Baths
No. Stories
El ALT. �I AD'N.
BLD. ❑ PLMB. ❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
No. Rooms
No. of Dwellings
❑ OTHER
DESCRIBE WORK
VALUATION SOURCE GAS I ELECTRIC WATER SEWER
OF
9. UTILITIES
1 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. EE REVERSE SIDE FOR REQUIRED INSPECTIONS
CERTIFICATE
of EXEMPTION
Enum. Dist.
Ownership
Public ❑ Private 0
Location (Area)
/ USE CODE
Req'd.
DATE OF APPLICATION SIGNATURE OF APP CANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Heald
/� / Pllanann
rwe
Fire Marshall
Co ng neer
Utilities
Plans Exa
Checklist
Tec
Req'd. Not RetYd.
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 $
14-
PERMIT N +IMBER
22 t A
02*
*7400
*74.00
*74.006
A *000
543.62
06- 03.81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
+Q;4;rx,8',1
DATE ISSUED PERMIT NO.
5'0;9 Z. *74,0020
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