1981, 10-07 Permit: 81B-0417 MH(PLAN NUMBER 3
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
JOBADDRESS �/7 �pI���vt�11 e I
BDI VI SION
1. L I1&OSU�t'A\
LOT / BLOCK 1 iJ W45et
OWN R
Pyr /Ca. 1C
ADDI:ESS �^' H�
CON'11�VITR(i OR - 1/�
ADDREs/EpSSS IV/l
2.
3.
4.
LEGAL DESCRIPTION -SEE ATTACHED
PHONE'
92° -7& r5
PARCEL NUMBER/S i555
II.
417
ZIP
�7
PHONE
174 277&
ZIP
DESIGNER
5. ADDRESS
PHONE
ZIP
Actual Set Backs in Feet
North (South 1� East to (West
Size of Parcel Z e Classlfi tion
- 1GO(o>c —cc_ . 14\i1C-
TyfeJConst. Opcupancy Sprinklered
\I N frq, ❑V s ❑No ❑ Req'd.
Valuation But !ding Area in Sq. Ft.
Main Floor Upper Floors Garage Area Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE LTiNEw
7. OF
WORK ❑ BLD.
DESCRIBE WORK
8. (7 YJ lib
O ALT.
O PLMB.
O AD N.
❑ MECH
0�RPL.
GH.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
VALUATION
s.I
50,0
149rill r& (1 - >d' +)
ELECTRIC I WATER
SOURCE
OF
UTILITIES
GAS
Enum. Dist.
Location (Area)
SEWER
116 -
Ownership USE CODE
Public O Private
I hel'eby 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 7 - / 7- D I
SIGNATURE OF APPLICANTti°nL'+rr�-C r�3>•'K.GfK.e-I'
SPECIAL APPROVALS
NAME DATE
Fe; He Ith.
LePtd
Plannin
Ire a shall
y//
Co. Engineer
tilo'r ;"1,.17..
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
C
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
oQ !j� 4'ua'retro-2
e., ^ (---10t-E-Mobile Home
ec{- +0 We -04 S2
PERMIT IS NONTRANSFERABLE
5a
Other (Specify)
TOTAL
$ 5o
PERMIT NUtv48SR
N1 - o4 -r1
0i_ *5000
•*50.00 65
*50006
A . *000 8
949.5
0,c/-174-81
4117.4
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
Yb' 181 ) 118illl
4L-7 -z •*5flO. i2
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL
›-
0_
V
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