1981, 03-06 Permit: 81A-2136 MHPLAN NUMBEK
3/(/k
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
4.
JOB ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNER
%4AUP'iAL-iRAFT
ADDRESS
E.12_0t6 'boar.; t.
CONTRACTOR
PHONE
421,
PARCEL NUMBER/S DrF'ock itt,.1t'iv 1r'i t)%
ui V2. of 04-i E,cc. cs,. i3q' txy, �� ar's EN:1S 'Le_
ito54I 6, 2.4 -
ZIP
Q(a
Actual Set Backs in Feet
North 'South Imo.
East �. IWest 10'
PHONE
Size of Parcel
e'5x6LC
Zone Classification
ALG, . JIx uie?Atli'
ADDRESSJ�
_5HInt
DESIGNER
5. ADDRESS
ZIP
Ty e Const.
T
Occupancy
Z-3
Sprinklered
❑Yes No E Req'd.
PHONE
Val ation
Vt 145b0
Building Area in Sq. Ft.
tAldi
ZIP
Main Floor I Upper Floors
C.
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
IYJ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
8.
VALUATION
9. iti5LU
DESCRIBE WORK
Ui of Alh8i a Name C.\4 X 641-)
Enum. Dist.
ILocation (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public ❑ Private LYJ
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
� - 6
SPECIAL APPROVALS
NAME DATE
Env. Health
1U�T IREQ'I,).
Planning
Ntrc asIA`>7.
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
SIGNATURE OF APPLICANT( `, U
SPECIAL CONDITIONS:
U�J1N2� I✓� t51 -(&c \CCO Aro K
f�1/J tl�r Nlih,s vcT.,>\r EYr111)6 116/0-CoRy176I{i1n,.1>4
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing_C
Mech.
Plan Check
SEPA
Mobile HomeO
r.
Other (Specify)
TOTAL
$ Sct . cx.?
PERM' C NUMBER
03* *9.00
*900 ti
*9006
A *C00
213.42
03'-064-81
2 6479
07* *5000
*5000 -
*50006
A *000 8
21352
03-06-81
2 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
a 314,0' el 81.
213.6,2 *59,00a� -
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
0
16'
85'
L -E ks-r R,E5