1981, 04-01 Permit: 81A-2940 ACPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
s
2.
JOB ADDRESS
LOT
BLOCK
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
SUBDIVISION
3 ADDRES
OWNS -� `/ f%
4.2."
2
PHONE
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S
4.
CON ,;'ACTOR
C- 6
DESIGNER
5. ADDRESS
ZIP
PH6Egg" yl
'i // 7c)
Actual Set Backs in Feet
North 'South East (West
Size of Parcel I Zone Classification
7C 7
PHONE
Type Const.
Occupancy
Sprinklered
Des ❑No ❑ Req'd.
Valuation 1 Building Area in Sq. Ft.
ZI P
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
8.
TO
Area of Decks
Finished Basement
Unfin. Basement
. NEW
❑ BLD.
DESCRIBE WOR
❑ ALT. ,❑ AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. 't M��ECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist.
ILocation (Area)
Req'd.
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELE TRI
WATER
SEWER
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. 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
SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
PVlech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT NUMBER
04* *14,00
*14.00 t
*14.006
A *0.00 8
293,92
04-01-81
z 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'4-01-B'1
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
29402 *1'400a E.
PERMIT NO. TOTA(