1981, 08-24 Permit: 81A-8468 MHPLAN N'_'MBEP
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
1. N . G \ 1 (3otJo \ Atli
LOT
2 to -o
BLOCK
3
SUBDIVISION
FIr�Y AD 110/v •io EAST S-R)v._.fkrve'
OWNER
3 e�
A • 1--ete...4-1
ADDRESS
14. e1 6-7 mAtt.)
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
13�i31— t\3L)
ZIP
(ACC MCC
Actual Set Backs in Feet
North 6 'South
l
East "2-IWest
4. ADDRESS
CONTRACTOR
4ar,nE
DESIGNER
ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
L✓J NEW
0 BLD.
O ALT.
O PLMB.
PHONE
ZIP
PHONE
ZIP
TO
O AD'N.
O MECH.
0 RPL.
V M. H.
O MVE.
❑ POOL
0 OTHER
Size of Parcel
Zone Classification
R .. i�1Cii�vli \-ko(
Type Const.
Occupancy
R-3
Valu tion
1'I, 000
Main Floor
1162–
Upper Floors
Sprinklered
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area
DESCRIBE WORK
8:1Pc SLG- +cam moiLEt . - x
VALUATION
9. 1-1, Ono
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
3�Pr°Ic;
Area of Decks
Finished Basement
Storage
Unfin. Basement
No. Baths
z
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
ILocation (Area)
Enum. Dist.
Ownership
Public ❑ Private
R
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-SIGNATURE OF APPLICANT
ECIAL APPROVALS
�.. NAME DATE
Env( He h
Planning
Fire Marshall
Co. Engineer
Kkrr Redo
Utilities
Plans Examiner
SEPA Checklist
din• echnician
SPECIAL CONDITIONS:
Ex►�T,al7t. S„�GL� U0I0e io ?Da 2E,mDuEo
in -1w 30 Dkf3
EXIST(Ike( 0AC 14
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
q'd.
Recd.
Not
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home ' 1ev-i' —
Other (Specify)
TOTAL
$ t CSO. Go
PERMIT NUMBE
I - Set -be
07* *100,00
* 100.00
* 100006
A *000
84672
08--24-•81
7 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'0'18 4
DATE ISSUED
8.1
Ii7
84'6:85
PERMIT NO.
00.:
knt
iJEAD MoSIt,€ Horne
26
2
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