1982, 05-19 Permit: 82A-3926 Repair 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. N
2.
3.
4.
LOT
� J l'Cc-L.-ACE
BLOCK ;U:DIVIS
LEGAL DESCRIPTION - SEE ATTACHED
5.
OWNER
ADDRESS
- . 8l1
CONTRACTOR
PHONE
ZIP
ac 2-c
PARCEL NUMBER/S N 1-� H 7N pN`3 ik►�• fJ • —PT.
Ltir Ltc. j3 N.7U' of C. I2.6'
eX- seri
Actual Set Backs in Feet
North —" ISouth
East
'West
GC
ADDRESS
N.1• 7
DESIGNER
PHONE
Sas'-FE1
ZIP
Size of Parcel 1 Zone Classification
Type Const.
Occupancy
Sprinklered
Oyes ❑No 0 Req'd.
PHONE
Valuation
LS e opt:
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
Unf in. Basement
TYPE
7. OF
WORK
❑(/NEW
CJ BLD.
O ALT. ❑ AD'N. [J RPL.
❑ PLMB. 0 MECH. 0 M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8.-CPA‘�
VALUATION
rt -PE r CD€-
Tc- �T3
Enum, Dist.
Location (Area)
SOURCE
OF
UTILITIES
GAS 1 ELECTRIC
WATER SEWER
Ownership ,,,//
Public El Private 1J
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
DATE OF APPLICATION s" / V.— Fi 2- SIGNATURE OF APPLICANT
SPEdIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Plans Examiner
SEPA Checklist
Sngi 1
SPECIAL CONDITIONS:..
R4.1"A•R. lw c{S 1 N a•"SFM6Ni
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
-
0Z* *1600
*1600
p(Q126006
A *11Q00 0
39252
05-19-82
2 6479.
02* *12600
* 12600
* 1 26006
A *0.00 0
39272
05-1982
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
05(44.9•? -82'
DATE ISSUED
59262 *126.0021 -
PERMIT NO. TOTAL.