1982, 09-30 Permit: 82A-8936 ResidencePLAN NUMBER
ifWS
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
JOB Ar DRE S
1. !■1 f21
LOT
2. I�
BLOCK
4
LEGAL DESCRIPTION - SEE ATTACHED
SUBDIVISION
L�',,s 01_4i Y"if3IA 1T1Oh;
3
4.
0Wr ER `I
AD RESS ) �T
s ' lj 1
CO RAFIC
P ON
`"jP lJk° lc'
HONE
PARCEL NUMBER /S
Actual Set Backs in Feet
North Ir.; 'South
JEast 4143 IWest
ADDRESS
ZIP
Size of Parcel
Type Donst.
Occupancy
Zone lassification
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
ZIP
Val}tir89__ j
ai Flo r �
Buildin Ar a in Sq. Ft.
� fr�►
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
i BLBLD. ❑ ALT. ❑ AD'N. ❑ RPL. 1=1 MVE.
D. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
Are ofgecks)
Ci Likic
No. Baths
Finished Basement
Unfip Basement
�1 /l
o. Stories
No. Dooms
No.Iof Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd"
Not Req'd.
l✓
DESCRIBE WORK
8. t.,1v
Enum. Dist. I Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership j.,USE CODE
Public ❑ Private 411117
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 INSPECT! • S
DATE OF APPLICATION ``�i SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
E ealth
P ning
Fire Marshall
Co. Engi
Utilities
Plans Examiner
SEPA Checklist
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 $ r'`
PERMIT NUM" \R
SSA -€5a
02* *25200
*252.006
A *000 g
874,42
09- 27'-82
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
89362 *292'OO8).j
DATE ISSUED PERMIT NO. TOTAL
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