1981, 05-05 Permit: 81A-4311 Fire DamagePLAN 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
1. S. :Z9 7 BALFoLAR.
LOT SUBDIVISION
2. 5 CHESYER HILLS ADDITION
B OCK
14
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S 2,95934
OWNER
JACK OWENS
ADDRE S
S.2tt17 BALFouR—
PHONE
Gin 1759
ZIP
Actual Set Backs in t
� t-xt�-rt ass
North South East
West
CONTRACTOR
4. PAc1Plc EN`rEAPRIsEs NotrHiefot(pas co)
ADDRESS
5712_ E. FIRs-r
PHONE
535—e737
Size of Parcel I Zone Classification
ZIP
97206
Type Const.
I! -NI
Occupancy
R-3
Sprinklered
Oyes ❑No ❑ Req'd.
5.
DESIGNER
PHONE
Valpation Oo
2.0 000 Ttje
Building Area In Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement 1 Unfln. Basement
TYPE 0 NEW
7. OF
WORK 0 BLD.
❑ ALT.
O PLMB.
O AD N. ❑ RPL. 0 MVE.
❑ MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Rpq'd.
DESCRIBE WORK
8. Fit- PAMAyE— Roor ANO sMQKE. DAMw c. /NreYelofL
Enum. Dist.
Location (Area)
VALUATIONy
9. 20JV a - kc
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership J
Public 0 Private IJ
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 INSPECTION
DATE OF APPLICATION -Ct.- 4I -
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
nv. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examine
SEPA Checklist
SPECIAL CONDITIONS:
BOLD ffOA P.oENE1QAL OF CO
CoNT'IZAGTDRS I/ALI.ATIoN
MAIL 'Co- cuNTAcroR. wl}eJ
�et-e
c-tbiS tl cs16I1 SE-
IZIAny.
✓�n� Op/3///0
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 ` $
PERMIT NUMBER
ekA `E31�
02'* *14000
* 14000
* 14Q006
A *00.0 8
428'8
05-04-8;1
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
VI516 els?!. 81111
DATE ISSUED
4311`Zi1�4a0:0-
PERMIT NO. TOTAL
d
U