1981, 10-25 Permit: 82B-0069 InsertPLAN 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 S
ADDRE
�f L4Jb
OT BL CK SUBDIVISION
"NAIL Lo i LLA i-D
/QA D 5116 KA M 1 -- cior
CONTRACTOR J
4. DESIGNER
5. ADDRESS
PHONE
61-74-1'.61.1 t 1
ZIP
PION
L
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
Z tri 2o b
PHONE
ZIP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North
South
Size of Parcel
Type Const.
Occupancy
East (West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation Building Area in Sq. Ft.
Main Floor
TO
❑ AD'N.
❑ MECH.
Area of Decks
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
Upper Floors
Garage Area Storage
Finished Basement Unfin. Basement
No. of Dwellings
No. Stories
CERTIFICATE
of EXEMPTION
No. Rooms
Req'd.
UA W�tl� 1 R GAS ELECTRIC G-�1� 1&)S e?
OF
9. UTILITIES
Enum. Dist. I Location (Area)
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 INSPECTIO
DATE OF APPLICATION ! 6 _ ' v v
� SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
mg T- � ician
i
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd. Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
WO
TOTAL $
PERMIT NUMBER
04* *20.00
*20,006
A *0.00 8
682
10-25-82
2 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
10-25-8'2
DATE ISSUED
69Z
PERMIT NO.
*20.00d1-2
TOTAL