1981, 05-12 Permit: 81A-4644 Residence Finish WorkPLAN NUMBER
L
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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
[6.0. 17 At L9A- A& t7
LEGAL DESCRIPTION - SEE ATTACHED
LOT
.z-
BLOCK
SUBDIVISION
OWNER
��1Ni ��s I
ADDRESS
A['A C - i50 Ci
CONTRACTOR
PHONE
-ocychP
PARCEL NUMBER /S F $ �'I (-*J Q'-
ZIP
PHONE
Actual Set Backs in Feet
North I �� ISout
East IWest2
Size of Parcel
14-7
Zone Classification
ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑NO ❑ Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
•f3-000 ate,
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
El NEW
LD.
❑ ALT. ❑
❑ PLMB. ❑
AD N. ❑ RPL. ❑ MVE.
POTHER
OTHER
MECH. ❑ M.H. ❑ POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
8.
DE $ RIB
v�1
VALUATION
9. 9QO
WORK
N I L(
SOURCE
OF
UTILITIES
GAS
d4&!) E CTRIC WATER
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Req'd.
Rec'd.
Not Req'd.
SEWER
Ownership
Public ❑ Private ❑
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
SIGNATURE OF APPLIC
SPECIAL APPROVALS SPECIAL CONDITIONS: I
Li
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ician
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 $C7 '
PERMIT NUMBER
02* *5000
* 5000
* 50,006
A *0,00
109.3g
02 -02 -81
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
05'-12 -B`1
DATE ISSUED
46 4.4g
PERMIT NO.
*5 a Oa I-
TOTAL
T-
CL.
0
U
w
J
U-