1981, 03-25 Permit: 81A-2754 AdditionPLAN NUMBERAPPLICATION/PERMIT
/1-2015 3/P.5 -A/
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. L f e BLOCK rIY. `'�'(ChS as
LO BoZ '/OCK B ISI
LEGAL DESCRIPTION — SEE ATTACHED
3
O,W NER
ADDRESS
.14122.1.449244../
, amt -O (L/X�,yr� .75..,,1
PHONE
g'2 -'f -so 7/
PARCEL NUMBER/5 67543—Q 22.7
/..4T . ,C3 /..K
t//STA C1:RRO,E,1/S
CONTRACTOR
��
Co
4. 1�
A�/,CfTI�/DRE•S''S
X iQ'/
ZIP
gel -to
PHONE
Actual Set Backs in Feet
North.t0 'South /0 East I West {d�
Sine of Parcel
ZIP
7cVX /7
Type Const.li
Occupancy
V- N g-3
Zone Classification pp gg
.�� �.da.U-
Sprinklered
Oyes ONo 0 Req'd.
DESIGNER
6. ADDRESS
PHONE
Valuation
SOODo
Building Area in Sq. Ft.
2100,
ZIP
Wain Floor
2007
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
NEW
0 BLD.
0 ALT.
0 PLMB.
54 AD N. 0 RPL. 0 MVE.
0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
NO. Stories
/
No. Rooms
/
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DES BE WORK QDD 11 -f-�
8. a /tA.xpo ,%3tett i1,a_-
zb'
Enum. Dist.
Location (Area)
VALUATION •I
9. d�06
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
SOU CE
UTILITIES
GAS
ELECTRIC WATER
SEWER
Ownership
Public 0 Private Cif
USE CODE
DATE OF APPLICATION //—oZJ — gO SIGNATURE F APPLICANT • 1 "1
SPECIAL APPROVALS SPECIAL CONDITIONS> -
4
NAME DATE
En
Plann
ng
Fire Marshall
Co. Engineer
Utllitle
Plans Examine
P u•
SEPA heckl
Bu Idin• Te mei
a-
4.S'AA AOr
Zoo 44
- 24.=
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building -
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERM/INUMBER' T
fs/A -2 7s$
02* *5000
*5000
*50.006
A *0100
4,20.58
11-25-80
6.4'79.
4
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE131r" :,Eli 2;7,'5 4'Z e'5'Q OMI°a.F,
SSLTED- PERMIT NO. TOTAL
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