1981, 11-13 Permit: 81A-3544 InspectJOB ADDRESS Yy�� //
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APPLICATION /PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH etI JEFFERSON / SPOKANE, WASHINGTON SAM / (WEI a663876
APPLICANT: COMPLETE NUMBERED SPACES — PRES`; HARD TO MAKE 3 COPIES
DWNER,/
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woDRlss A
CONT/r < ggR� /
D ESIGN R
6' ADDRESS
CHANGE OF USE FROM
1
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBERS
Ip Actual So Backs In m
PHONE Nr. of Pica 150010 1
orth
2otn. DB..Iny 1000
ze
Type Con, 0x00.000
PHONE
Valuation
Spslnklw.e
DIM 0NO ❑ Rye.
Building Ary In Se. Fl.
Zip
loon Upper moors I canon Ary
TO
Arm of Dyke
B•ym.nt
Unnn_ B.Mmmt
TVp! Afr NEW t3 ALT. ❑ AWN. ❑ RPL. ❑ MVE.
7. wog. O BLD. ❑ PLMB. ,JMECN. ❑ M.N. ❑ OooL O otot.
D ! CRIBE WOVE
r1.4f /z. --•rI /
a I ssZ / if;;;(// VALUATION' MAUVE �OAs ELECTRIC WATER
IUr471.1 eI EWER
OS
CERTIFICATE 1
of EXEMPTION
om. piss. !Lout an IAry1
Ownership
000110 D P%NM. 0
t hereLy certify that I have reed and examined this application and have lead 11.. ' ' " uclud,•d
oo every side, and know the same to be hue and correct. All Provinons 01 I.r u: er • ',Imalcesu n s u 'Ir . govenit type Of work will be Complied with whether specified herein ui run . 11,e granlurg ro nom,' does nnl Ine ulna
to pee authority to violate or camel Alt provisions of any oilier state or Incdl id
performance of construction. SEE REVERSE SIDE FOR REOUIRED INSPECTIOII' ns .L. r�r�„ .a n,.. •
DAIL OF APPLICATION? - /�_JY/ SIGNATURE Ur A0PI.ICANT ifilr/A.e/g'04./
MCIAL APPROVALS SHWAS. CONDITIONS:
NAME OAT'
USE COD/
A
o. Rooms ro. of Dm...
y e. I * 'a. Not
FEES COLLECTED
Si I l
Building
Plumbing
Plan Chgek
5EPA
Mobile Nome
other ISENINl
TOTAL 6 // F
� ,; UMB;115 44
^4• •14.0
*140
• 14.0
A •000
04 -14 -81
A 6479.
.0t sg
INSPECTION RECORD
OWNER LOCATION
CONTRACTOR
N S E W
SET BACKS
TYPE OF WORK
FINAL INSPECTION:
DATE REMARKS: