1983, 09-30 Permit: 83A-9784 Pole BuildingPLAN NUMBER
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
1.
2.
3.
JOB ADDRESS
/Z.5 -c 1
SUBDIVISION
LOT
BLOCK
OW ER
c' v /m e 701147',4 /)1 D Al
ADD
ESS
PHONE
f
ZIP
990.31
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S ) 654di+ j
5,/70'74. .3D 7� Ac-6/v�
.o .5
Actual Set Backs in Feet
North / l0 'South
CIO
East 'West ?
C RAC R
4. t "fYi
D (2 ESS
tri_ >t -
DESIGNER
,62
5' ADDRESS
6.
CHANGE OF USE FROM
TO
PHON
ZIP
77
PHONE
Size of Parcel
3o
TypeConst.
Occupancy
M -i
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
ZIP
Valuation
ger
Main Floor
«7,4
Building Area e✓ in q. Ft.
Upper Floors
/C
Gara a Area
fi
Area of Decks
Finished
Basement
Storage
Unfin. Basement
/✓JA
TYPE
7. OF
WORK
Q -NEW
BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
O M.H.
O MVE.
O POOL
0 OTHER
DESCRIBE WORK
8.
VALUATION
7 - A)o S4_q/3
SOURCE ELECTRIC
OF
9. UTILITIES
GAS
WATER
SEWER
No.jB�aths
No. Stories
No. Rooms
No. of
,?
ERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public 0 Private 0
Req'd.
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 .34 f3 SIGNATURE OF APPLICANT 4
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
63>N 1
SEPA Checklist
BuildirkyTechnic
SPECIAL CONDITIONS:
•
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
$
TOTAL $ (4•
7 1
02* *68:00
*68.006
A *.0.00 8
977.92
09=-304=83
2 6,47,9.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 9 r+ 3� 0 ,8� 3
DATE ISSUED PERMIT NO. TOTAL
9 7 8„4'z
*68.00°
COOK BROTHERS CONTRACTING
Route 2 Box 853 13
OTIS ORCHARDS, WA 99027
(509) 924-1557
JOB J[ 6i. ( /14C /14/9 Ai A 44
SHEET NO /V- e oividLNIY
CALCULATED BY .
CHECKED BY
SCALE i_r_r
—
DATE
DATE
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