1981, 04-14 Permit: 81A-3477 ResidencePLAN NUMBER
F344 -
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 AD DRESS
,. k1. I'iI AR Ti
LOT BLOCK SUBDIVISION
2. 1-3 4- LJ rr6
3.
4.
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
146 1 \ VL Dt,J
ADDRESS
5-, 1001-7
CONTRACTOR
ADDRESS
DESIGNER
5. ADDRESS
6.
boo
PHO E
�.. • 7 -7
CHANGE OF USE FROM
TYPE
7. OF
WORK
PHONE
ZIP
PHONE
ZIP
TO
u NEW ❑ ALT. ❑ AD'N.
Ch /LD. ❑ PLMB. ❑ MECH.
DESCRIBIE WORK
VALUATION
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
PARCEL NUMBER /S +,)
Actual Set Backs in Feet
North South ./-)
Size of Parcel
I9axB
Ty1pe iConst. Occupancy
Valuatatioo
n
Main Floor
6 2
Upper Floors
Area of Decks,
7) Ch.6\i )
No. Baths
IEast"- West
Z ne 4 Classific ion
CJ7 LJ1.
Sp inklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
No. Stories
N o.
ooms
Storage
Unfin. Basement
No. of Dwellings
fV t
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
SOURCE GAS EL CTRIC WAT�E/j�i SEWER Ownership USE CODE
9. UTILLITIES Co v1 M ' f /{11,C (Public ❑ Private
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse s ide, 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 auth ority 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 INSPECTIO,i
DATE OF APPLICATION 4-z-- L-` Jj /
SPECIA L APPROVALS
NAME DATE
SIGNATURE OF APPLICANT
n, ealth
Planning
Fire Marshall
*/2
o. Engineer
tilities
4/z f i
Plans Examiner r�
II Ai Pos�c.rw�1 1131a/
SEPA Checklist
SPECIA _ CONDITIONS:
cot,.- . ���- l,s - o
iz'12/�1 r J i / st. -13)
Req'd
Rec'd.
Not Re
2OI f�Z
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
$1
FEES COLLECTED
Single $
Building
Plumbing
201/ech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUN,.e'k;
to° 77
02 * '* 1 9 3, 0,0
4 1 9 3 0.0 N
'* 1 93.00
A *0.00
347.6ag
041 -14 -81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'4;1- 14 ''81`
DATE ISSUED
3 4 7' 7' Z *' 19 3e, 0,0 0 -
PERMIT NO. TOTAL
3 TL
1000 4,4.6 ser oc. 7,44,1K
-
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