1981, 01-16 Permit: 81A-563 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
1.
2.
3.
JOB ADDRESS
2.302- E LAKE
LOT BLOCK
OWNER
(Apt u....1rim Os C•larvIDE/Q
SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PHONE
C'i —Z67n
PARCEL NUMBER/S
ADDRESS
S , 23az
ZI P
99Z -k C.
Actual Set Backs In Feet
North (South East (West
4.
CONTRACTOR
5/ant E
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
5rarn€
DESIGNER
5. ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes No ❑ Req'd.
PHONE
Valuation (Building Area in Sq. Ft.
ZI P
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
L9 NEW ❑ ALT. 0AD'N. 0 RPL. 0 MVE.
❑ BLD. 0 PLMB. V MECH. ❑ M.H. 0 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. 1O� Ov6
OF
9,
Enum. Dist.
Location (Area)
UTILITIES
VALUATION SOURCE
TIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private 0
USE CODE
I hereby certify that 1 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 /7e. SIGNATURE OF APPLICA7
SPECIAL APPROVALS
NAME DATE
Env. Health
Plan n.na
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech. +17 - c:12'
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 1-7•c)6
PERMIT NUMBER
Ski) 503
04*
*17.00
* 1 7.00 tz
562,2
01-16-81
L3 6479.
•1
WHEN
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
01116-811
56.32 *17.00°a0
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL