1982, 04-26 Permit: 82A-3143 ACPLAN 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
•
SU80EV1ST
o�v
LOT BLOCK
2.
3.
ow R'
c' 't.12 C.�E' Ciemeleto
D�.ESS / q
C TRACTO
AD
P ONE
<719
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
PHONE-,
Actual Set Backs in Feet
North (South East 'West
Size of Parcel 1 Zone Classification
ADDR SS
DESIGNER
5. ADDRESS
PHONE
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
Valuation (Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors I Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ NEW 0 ALT. 0 AD'N. ❑ RPL. 0 MVE.
❑ BLD. ❑ PLMB. , NQ 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 Req'd.
DESCRIBE WORK
8.
VALUATION
9.
(' r
SOURCE GAS
OF
UTILITIES
ELECTRIC
7
WATER
SEWER
Enum. Dist. l Location (Area)
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. Th: anting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or I cal law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INS' CTIONS ,q_ -
DATE OF APPLICATION 114�/s� 2— SIGNATURE OF ' • 15`74-f-(/!1Jf -'Z't-`A-J
111.
SPF.CIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
uilding n cia lb
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
PERMIT NUMBER
A --lq-�
04* *14,00
* 14.00
* 1 4,006
A *0.00
3142g.
04-26-82
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 4-2' 6'- 8 2
31 4.3( *140 0°
DATE ISSUED PERMIT NO. TOTAL