1981, 09-16 Permit: 81A-9381 AdditionPLAN NUMBER
`/G
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
2.
JOB DDRESS
33o
LOT
BLOCK
3.
LEGAL DESCRIPTION - SEE ATTACHED
SUBDIVISION
6141\17-49AJ ?
OWNER
GS}' klI k
AD REBS
wTh
PHONE
ZIP
777--e G
PARCEL NUMBER/S 00543 543 4-Zc2
I54-.3-;- OF- t,c14.. 91
CO TgR
ADDRESS
PHONE
Actual Set Backs in Feetjj��
North JSouth dEast
Size of Parcel
140?< 154-
IWestYZ
Z e Classification
ZIP
Typ
o n st.
4.72
Sprinklered
❑Yes ❑No 0 Req'd.
5.
DESIGNER
PHONE '
ADDRESS
ZIP
Valva o
Upper Floors
Main' Floor
77_0
Building Area in Sq. Ft.
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
741.a.
7.
TYPE
OF
WORK
EW
ivgd BLD.
❑ ALT. Er/AD N. 0 RPL. 0 MVE.
0 OTHER
O PLMB. 0 MECH. 0 M.H. 0 POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DErSCRIBE WORK
8. ' res-i.OE
VALUATION
9.
SOURCE
OF
UTILITIES
"19a10N1
GAS
Enum. Dist.
Location ;(Area)
ELECTRIC
WATER
SEWER
4'_1 GJ
Ownership
Public 0 Private 0
USE CODE
I hereby certify that I have read and examined this application and have read the'
on reverse side, and know the same to be true and correct. All provisions of laws
type of work will be complied with whether specified herein or not. The granting
to give authority to violate or cancel the provisions of any other state or local law
performance of constructi. SEE REVERSE SIDE FOR REQUIRED INSPECTION'S
'NOTICE provisions included
and ordinances governing this
of a permit does not presume
regulating construction or the
VDATE OF APPLICATIO
SPECIAL APPROVALS
• NAME DATE
Enj H alth
-dA4441 V/5-7
Planning
Fire Marshall
Co. Engineer
Utilities
Pla s E miner
SEPA Checklist
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building ' 152
Plumbing
Mech.
Plan Check
SEPA• ,•
Mobile Home
Other (Specify)
TOTAL $ I Y
PERNIti'NUMB.R
g, -i e
02* *15200
* 15200
* 152001i
A *00,0 8
.930,22
• 1:J9-14,4;81
g 6479,
1'"
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMESA PERMIT.
91'3 X8.1. z
DATE ISSUED PERMIT NO.
*152'0'0
TOTAL
N3_368 C n 1�e,2 _ PLO PL
1'
7s,
4q1