1981, 05-06 Permit: 81A-4430 DemoPLAN NUMBER
.
APPLICATION/PERMIT
5/6/g/
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.
JOB ADDRESS
LOT I 1 [1 r
B OCK
LEGAL DESCRIPTION — SEE ATTACHED.
SUBDIVISION
3.
OWNER
l/Cs ✓V)CNS
I
94-1405
PARCEL NUMBER/S / t� A ` o ✓_ 7
Fri -OG '+i -2S3 yr, of V2. I Cc.
W. foo + r4c, 14 , 1 51 OF of
AD IT r - r./OD{J I'
ZIP
Q/:a/-7_‘J 1p
Actual Set Backs in Feet
North 'South East 'West '
4.
CON T06
PHONE
Size of Parcel
?e->-10
Zone Classification
ADDRESS
ZIP
Type,Const.
Opt cy
'Sprinklered
Dyes ❑NO 0 Req'd. '
5.
DESIGNER
PHONE
Valuation
Building Area In $q. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE 0 NEW
7. OF ✓
WORK LF BLD.
❑ ALT. 0 AD N. 0 RPL. 0 MVE.
❑ PLMB. 0 MECH. 0 M.H. I] POOL
OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not 5'd.
8.
DESCRIBE WORK O E&t � NI
tLl'fl��
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 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. 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
— � SIGNATURE OF APPLICANT
DATE OF.'APPLICATION
SPECIAL APPROVALS .
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
3-0
Other (Specify)
TOTAL $
PER IT NUMBER411(
bid I Ac 44 30
02* *2.1300
*2000
442,92
10 05 -06-8.1
i 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
4'4,3.0 _; *2 0. 0 0
DATE ISSUED ; PERMIT NO. TOTAL