1981, 09-29 Permit: 81A-9940 Pole BuildingOwnership �`
Public ❑ Private �f
PLAN 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
N, ! 7-ez 6/94/4/4--4/
LOT BLOCK SUBDIVISION
2. yda,r.-4/1/,14A'S Sat l v
ER
3. iCA Lor',q .63iii/1 619,e J .v e.
ADDRESS
C NTRAACCTOR
4. ADDRESS
xlc?a LEI.
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
4SJEW ❑ ALT.
XBLD. ❑ PLMB.
ZI P
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
3.5-6 4/3 o -J
Actual Set Backs in Feet II �
North g t 'South 7 1East /91 (West /7
Size of Parcel II Zone Classification
E, L_
PHONE
ZIP
TO
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
‘,2/cX c
Type Const.
Valuation
.4t3 J-c7
Main Floor
Occupancy
Zvi •l
Upper Floors
DESCRIBE IORK
/Jz.t-
A VALUATION
'62-C)
SOURCE
OF
UTI LITIES
GAS
WO 6-4 Ai C, ..3 c `9 •;
ELECTRIC
WATER
SEWER
Area of Decks
No. Baths
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
Finished Basement
No. Stories
CERTIFICATE
of EXEMPTION
Enum. Dist.
()
Storage
/C)6P()
Unfin. Basement
No. Rooms
No. of Dwellings
Req'd. Rec'd.
Location (Area)
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 j.��_ /� /,
DATE OF APPLICATION 1�_�.J �. SIGNATURE OF APPLICANT 0 %14�1.Lt -[ iCs�
SPECIAL APPROVALS
NAME DATE
Env. Health
(I-IAA/NO
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
IVc c ( Qt iJ
SEPA Checklist
Icl g Tec ician
C- 20/0-
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building 4.so.'
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBFR
BiA LIC440
*5000
*5000
*50.008
A *000
987.;02
09, -25 -81
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
2.; 9,
8 '1'
99402 *50,00a°IJ-
DATE ISSUED PERMIT NO. TOTAL
COOK BROTHERS CONTRACTING
Route 2 Box 853 B
OTIS ORCHARDS, WA 99027
(509) 924 -1557
JOB
r•
••:T.
SHEET NO V 91D . gAjwe /y Pd
CALCULATED BY DATE
CHECKED BY
SCALE
DATE
_ALL/
Aafoot
£c/S trirq
- .14' -A
FOAM 204 Available from ( ES/INC Townsend. Mass 01470