1982, 05-05 Permit: 82A-3504 ResidencePLAN NUMBER ,,,,M
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
CP/
,. JOB ADDRESS
1.
LOT
2.
BLO
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
N. 46getE3 e-V6QA¢.g v
CK SUBDIVISION
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3. Msc..Utry
ADDRESS
N.40.\i A44-10oJ
CONTRACTr9R
4.
PHONE
428 —U?('
PARCEL NUMBER/S E "336 Of g>Z441 Oi
OF -ra..
02••54,--2- --AbOk
ZIP
gor 2k
Actual Set Backs in Feet
1South �j� East IWest CpC,
North
PHONE
Size of Parcel
5.
ADDRESS "
DESIGNER
ZIP
Type Const.
Occupancy
Zone Classification
A62-1CAAI-1-1/4A. CAM—
Sprinklered
❑Yes ❑No 0 Req'd.
PHONE
ADDRESS
ZIP
aluation
$12�L
Main Floor
lVA
Building Area in Sq. Ft.
i \tet C.
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7, OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8• Si ivE, CE prvk
VALUATION
9.
Enum. Dist.
Location (Area)
SOURCE GAS ELECTRIC
OF
UTILITIES
WATER
SEWER
SErtc
Ownership
Public 0 Private
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 INSPECTIONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
Env J 4 alth
Planning
Fire Marshall
Co. Engineer Q
T [ZSL �18f Sz
/iy
Plans Examinee
SEPA Checklist
ing Technician
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
C 7`T c rV it 71-r •I-PQzcr—.-t'Y"
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building frZ.70.
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
L* *27000
(0
*27C006
A * is 1: 0
3
05_05-R2
6 d 79
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
03A'•:'05`-''82 35449 *27O.00a-
DATE ISSUED
PERMIT NO. TOTAL
C
L
L
5
33C' , 51' IVB lqg'r, 7r 7
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