1981, 04-08 Permit: 81A-3259 ResidencePLAN NUMBER
'Z- SIA
ilf/i/e/
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
BLOCK
LOT
LEGAL DESCRIPTION — SEE ATTACHED
SUBDI [SIO
2. // // KV -e .f,/�' XIA i/L-
OWNER
3. .4V(70'
4
PARCEL NUMBER/S �{— �_ ////
PHONE
—e7
AD RESS ZIP
PHONE
Cc NTRACTOR
AI0DRESS
DESIGNER
5' ADDRESS
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
NEW
BLD.
❑ ALT.
O PLMB.
ZIP
PHONE
ZIP
TO
❑ AD'N.
O MECH.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
._O T 47; ,c_dy7/
ArI'ff»/1 RA/tic'/7' ALit;
Actual Set Backs in Feet
North r� (South 4Ii East /e.; / IWest 37
Size of Parcel /
9
Type Const.
—N
Occupancy
Zone Classifica,tion
Sprinklered
❑Yes No ❑ Req'd.
V
luation
Main Floor
Upper Floors
Area of Decks
Building Area in,Sq. Ft.
Garage Area
Finished Basement
DE CRIBE WORK
8.
VALUATI N SOURCE
9 -7 5 // L
,oma TILITIES
/GAS
ELECTRIC
WATER
SEWER
CERTIFICATE
of EXEMPTION
Enum. Dist.
Ownership
Public 0 Private
Storage
Unfin. Basement
No. Rooms
No. of Dwellings
/
Req'd. Rec'd.
Not Req'd.
Location (Area)
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 --{-k/ SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
41491
Fire Marshall
Co. Engineer
�t)
Utties
L1
/a
Plans Examiner
n/ Ike Pciiirvs
SEPA Checklist
Buiuilding7 Technici )n
SPECIAL CONDITIONS:
(,N
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building ,1_416.-
Plumbing
2=4 ;
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBEit
8�R-3z 9
02* *20600
*20600 17,
*206006
A ',000
325.82
04-08-81
z 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0;44j 3'25,9 z.
DATE ISSUED PERMIT NO.
2'0 6. 0'01 ---
TOTAL
_
9 -3 Lt---)
61,745 I1F1-- 101
y • f\
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9
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