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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