1982, 05-19 Permit: 82A-3915 Gas HWTPLAN NUMBER
APPLICATI9 /PERMIT
PERMIT NUMBER
bAA
b
SPOKANE COUNTY - ButG CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
„ APPLICANT: COMPLETE NUMBERED SPACES — PRESS
HARD TO MAKE 3.COPIES
JOB ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
LOT
B O K
SUBDI ISION
PARCEL UMBER/S,
O O
2'OW
R.
42-
ONE
/
4��s.
* 1 6.0 0
7
* t 6 o
o
A RESS
ZIP
Actual Set Backs in Feet
A 'f O O O U
North South East West
,
CON ACTOR
PHONE �fa7,z
size of Parcel
Zone Classification
3 91.4-9
4.
AD SS
ZIP
Sprinklered
0 5-19.-8 2
C9/5 /S 26❑Yes
7pe77Occupancy
❑No ❑ Req'd.
DESIGNER
PHONE'
Valuation
Building Area in Sq. Ft.
6479-
479.5'
5.
. ADDRESS
T IP
Main Floor Upper,
Floors
Garage Area
Storage
_
CHANGE OF USE FROM
TO
Area of Decks
Finished Basement
Unfin. Basement
6.
TYPE ❑ NEW ❑ ALT. ❑ AD -N. ❑ RPL. ❑ MVE.
No. Baths
No. Stories
No. Rooms
No. of Dwellings
7, OF��/ 11OTHER
ElBLD. El� PLMB. �-1MECH. ❑ M. H. ❑ POOL
CERTIFICATE .
Req'd.
Rec'd..
Not Req'd.
WORK
of EXEMPTION
DESCRIBE WORK
/
Enum. Dist.
Location (Area)
FEES COLLECTED
8
VALUATION
SOURCE
GAS
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9.
I UTILOITIES
Public ❑Private ❑
Single $
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
_
Building
type of work will be complied with whether specified herein or not. The gr ng of a permit does not presume
to give authority to violate or cancel the provisions of any other state or to al I w regulating construction or the
performance of construction. EE REVERSE SIDE FOR REQUIRED INSPEC NS Plumbing
DATE OF APPLICATION" SIGNATURE OF APP Mach.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
+
NAME DATE
xl Plan Check
Env. Health
SEPA
>
Planning
O
- U
Fire Marshall
Mobile Home
W
—r
U -
Co. Engineer
Other (Specify)
Utilities
6�
TOTA L $
Plans Examiner
WHEN MACHINE VALIDATED
IN THIS SPACE,
SEPA Checklist
THIS BECOMES A PERMIT.
�9 �
3'9 0116 a j
Bu Tec an _
PERMIT IS NONTRANSFERABLE Q�il 1 ,$ i2
.15,11
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
PERMIT NO. TOTAL