1981, 09-10 Permit: 81A-9153 MHAPPLICATION/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
1. 2.(0Z3 N b M1‘401.)1)
LEGAL DESCRIPTION - SEE ATTACHED
LOT
2.
BLOCK
(9
SUBDIVISION
EAeree Rd. Moeil-E I -401,A65 Is+ ADD
OWNER
s. an-I-lcE G St& iA 2T"
ADDRESS
2-Lo2.5 N , O21kYYt moND
PHONE
R2'4-58-140
ZIP
PARCEL NUMBER/S
08552-M0 I (-Rom MtLE
Actual Set Backs In Feet
North /S South
I
East
West r I
I��jI
CONTRACTOR
4' ADDRESS
PHONE
Size of Parcel
13X 17.7 .TRE
Zone Classification
ZIP
Type Const.
Occupancy
23
Sprinklered
Lyes ONo 0 Req'd.
DESIGNER
5' ADDRESS
PHONE
Valuation
tiS, arra -
Building Area in Sq. Ft.
i `H
ZIP
Main Floor
k Li
Upper Floors I Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfln. Basement
7.
TYPE
OF
WORK
O NEW
O BLD.
O ALT.
O PLMB.
O AD N.
O MECH.
❑ RPL. 0 -�1 V E.
0 POOL
0 OTHER
No. Baths
2
No. Stories
No. Rooms
5 -
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. DO(tiRLF ((�llh✓ 1AD1�1�
VALUATION SOURCE
s. yS,avv UTI LOITIES
GAS 1 ELECTRIC v 0
Enum. Dist.
Location (Area)
ATER
SEWER
ti6PrC.
Ownership
Public 0 Private pal
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 INSPECTIO
/DATE OF APPLICATION
10 -
SIGNATURE OF APPLICANT.
SPECIAL APPROVAL
NAME DATE
Env. Health
cne9a9VFD 21a.— Qres-ew4
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Bull c Te Icl9/
SPECIAL CONDITIONS:
7 -
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne 100
Other (Specify)
TOTAL
PE ftteTIT 1 JOMBER
BIA-a(ts3
07* *10000
*10000 17)
*100006
A *000 8
9;15.2
09-10-8'1
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
O'Nj,1110i1r!8 f1
DATE ISSUED
91.5:35' *100.00RD,!
PERMIT NO.
TOTAL
jt" VreV OtTY • "
LoHla44.0., alitrePet.
. rm. afiegto,\H
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Scp
fisiziwer9.414., 024 )1 6
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t j 461 4 . „ . itiOtAillf4P
•
OP -:411 Ls Ita toll 6-te kr
/97,s1
4723 L_DRIA.mmoNd
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