1982, 09-30 Permit: 82A-8934 Residencec
PLAN NUMBER
4/,
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
1.
2.
3
4.
JOB ADDRESS
Cpl AxaC �T
LEGAL DESCRIPTION - SEE ATTACHED
5.
LOT
OWNER
ADDRESS
CONTRACTOR
Awl
ADDRESS
'5A�
► Y 46
DESIGNER
BLOCK
i
SUBDIVISION
Ct.t>f
1t )roi1 i.Gr�
PARCEL NUMBER /S
PHONE
$1`210 — i Jlv i
tNT
ZI P
1642426'
PHONE
Actual Set Backs in Feet
North � 'South
Size of Parcel
►31x i55
East 1
Zone Classification
Str�C4rE FtAwtt ,—y
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
ADDRESS
ZIP
aluation
7Gc
Main Floor
Building Area in Sq. Ft.
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished
Basement
Unfin. Basement
14—
7.
TYPE
OF
WORK
eNEW ❑ ALT.
(BLD. ❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
N o. Rooms
No. of Dwellings
DESCRIBE WORK
8.
VALUATION
9.
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Noyeq'd.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership �/
Public ❑ Private LT
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 INSPECTION,
DATE OF APPLICATION
SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
En Health
PLC -fling
Fire Marshall
21 /�/^
Utilities `—t; /��/ C//
q /3D
Plans Examiner
r4
SEPA Checklist
Building Technician
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 $ Z`O- a,
PERMIT DIUMPFP,
024, *24600
*24600
A *0.00
857,1
09 ,-22 -82
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'9- 130 -82' 893.41 *246.0021
DATE ISSUED
PERMIT NO. TOTAL
O3
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