1982, 05-25 Permit: 82A-4140 A/CPLAN NUMBER
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 ADDRESS
LOT
c�
BLOCK .(>2SUDICiSQ
3. OWN
? l dAd
ADDRESS
4.
CONT CTOR
AD
DESIGNER
5. ADDRESS
CHANGEOF USE FROM
6.
TYPE
7. OF
WORK
PHON
Z
ZIP
PHONE
ZIP
TO
❑ NEW ❑ ALT. 0 ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. ECH. ❑ M.H. ❑ POOL
❑ OTHER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North 'South East (West
Size of Parcel
Type Const. Occupancy
Valuation
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Main Floo
Upper Floors
Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
DESCRIBE CORK
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTjRIC
WATER
SEWER
Enum. Dist. I Location (Area)
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 g,. ting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or I. . law regulati:g const --- ion or the
performance of construction. EE REVERSE SIDE FOR REQUIRED INSPE . IONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ch cia
SIGNATURE OF APPLI
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
/U L
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ /1/
PERMIT NUMBER
04* * 1 4,00
* 1400
* 14.006
A *000
41392
05-25-82
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
!, a
0`"5 S( -8'2 4140 Z * 14 0 0 a-
DATE ISSUED PERMIT NO. TOTAL