1981, 04-23 Permit: 81A-3854 ResidencePLAN NUMBER
"-FM— /f$5 3/1/
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
LOT
Eln SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
3.
OWNE�'i��` , �
DRc _ I�
ADESS ' �,,
�, 170 1 GAk21J,F4 J\j
4.
CONTRACTOR
PHON
PHONE
Actual Set Backs in Feet
North !South .32-- East
Size of Parcel
ADDRESS
ZIP
.200 Type oust. IOcc ncy
(West 3a"
Zone ca
Class'fit' n•
i w//
Spri kl4�re�
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuat'on
• 49,12,
Building Ava inSq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Gagi Area
Storage
CHANGE OF USE FROM
6.
TO
TYPE
7. OF
WORK
El/NEW 0 ALT. 0 AD'N. 0 RPL. ❑ MVE.
k�J BLD. ❑ PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
Area of Dfickf Finished Basement
r260.)I-7�
No.Baths No. Stories No ooms
Unfin. Basement
No. of i wellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not R
DESCRIBE WORK
8. i2i f ,t 7
VALUATION
9. 460 gto
SOURCE
OF
UTILITIES
ELECTRIC
YV ✓V �'
SEWER
Enum. Dist. I Location (Area)
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
DATE OF APPLICATIONl�l/v/O/ SIGNATURE OF APPLICAN
SPECIAL APPROVALS
NAME DATE
Env. Ith
€ 7/r
Planning
Fire Marshall
Co Engip e
Utilities
Tot to S7 wArt RC2 -3/*
SEPA Checklist
Plans Examiner
SPECIAL CONDITIONS:
CXR S4-4kc \)-e g Qk Q U -e $ C, K
•
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ n.
PERMIT NUMBER
-��
02* *28300
*283.00
*283.006
A *0.00
3853
04-23-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
��2'31-131,
lio
DATE ISSUED
38'5.14'2 *'2'83.0O2g —
PERMIT NO. TOTAL
F!I F C(lPY
CARNAHAN
ID
ID
r0
0
0
a>
83) 26 52V 299 '-+
cis
in
Drvewcy
TRACT
B ,
N85° 3736E
30,3
RACT
A
N 89° 2740'
0
.11111111011111111=1....
30
STATE OF
COUNTY
executed tt
act and clef
set my hanc
• 3/4'Iron P pe
in con
(\I
1/2"X 24" Rebor
W/ plastic cap
0 Mkd LS 8410
CO
re)
rr)
'1"110 3/4" Iron Pipe
in copc.
NOTE;
Original survey made by Phillip
LS4413 H