1991, 07-12 Permit App: 91004191 MHSpokane County
DEPARTMENT OF BUILDING & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
PARCEL NUMBER:
INFORMATION WORKSHEET
STREET ADDRESS: /`�! O C, /,,j4 /111
CITY/STATE/ZIP: U' E//\ f�iZ; // lI/
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
# OF BUILDINGS:
OWNER:
# OF DWELLINGS: WATER DISTRICT:
IIT. -4)/ 1J/9 -/,1),0C' , &
MAILING ADDRESS:
//Pe/ e /r;e%',1_,P
PHONE:
CITY/STATE/ZIP: S s1,277)-1/ /17
CONTACT: PHONE:
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE:
****************************************************************************
CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
BUILDING INFORMATION
PHONE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.:
REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL:
SPOKANECOU 1TX_'DEPARTMENT OF BUILDINGS
•
W. 1403,SAGADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit/application, state that the information contained in it and submitted by me or my agent to compile said permit/application is true
and correct, and authorize Spokane County to proceed with processing. In addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE
provisions included herein and agree to comply with same. All provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not. I understand that the issuance of this permit/application and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to
give authority to violate or cancel the provisions of any state or local law regulating construction, oras a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT N!.iMBr:R:::: 9100419.i APPLICATION DATE= 07/1 2/91 i•`A,;:. F:.
***Y,* THIS Ts NOT t, PERMIT )r*.;;.' p•..x.
PENALTIES W:Li...L. BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 1108 J C i:Ft:r'F:) RD i:: )FiCE i...:"- 13531-1170
1...,•..•
ADDRESS= SPOKANE Wt's 9921 2
PERMIT iUSE= DOUBLE Wl'rtF: MOBILE HOME ... REPLACED BURNED DOWN PE:.i.T)r•i•iY::.
F'l...F^,Tm::::: 003014 Pi..,nT NAME= 1;sT ADD TO ,..A,`.•" -T- SPOKANE
BLOCK= 1..1 -OT:.: <, ZONE= 1."•N{ ',T ST'4:- 1.
AREA= !:: A`. 4. WIDTH= i -2o DEPTH= i`''T H:::: ti r', I ..
OF BLDGS= " DWF;...i...:i:i'dC•;S= i WATER i i:,: T =
OWiNE:FZ:::- I._TNDEGiw.FN, PATRICIA
STREET= 1100 N 'i'.TFir.".tR T) RD
ADDRESS= SPOKANE WAS °921
BUILDING
CONTACT NAME= PATRICIAL..1'r1DF:GREN PHONE i`!I.i,'1FiE`F =
Ft.IIL..DING SE-.T:EtA(�:K : FFtO�.J.T. EX:F;i LEFT= i::xJ ' r:FGHT::. EX:[ E REAR= EX:1:2
* u: -h' -h: * •x' •ir ii, * * # •x is n:• * * •1i t+: •k •ie v% * a+:• * ar, •ir• •,r * );: REVIEW INFORMATION ,ii),...x..b:.)!• X x• 3i. •ri f': •k r: x ;C. it N.:a:.p: b..
DEPARTMENT REVIEW COMMENTS
HI:::Ai... TH:(?14'T NEW OR ADDITIONAL i... WASTE WATER
r;.i1::'i::'RfiVryi... COMMENTS
- 9/ se.t)
;+: x:.x. . * * * X..x..x..x. 7r•• .x a,:• 3 .)i..p:• * * 'b: •x 4 •)i• 3: i{• x• ii• *• x• * MOBILE H(iMlF PERMIT * •if n: •i+; ..x..x. * r;.:r.4 :R..x.:. x• A =n:..,,y..i;.
CONTRACTOR= UNKNOWN
SOWN
STREET= UNKNOWt-J
ADDRESS= UNKNOWN WA UNKNOWN
YR/MAKE= 199'1 1ARi...ETT'F: IOD,._
:.Er n iO:WIDTH= TT " <4 LENGTH= y 2
HEIGHT= ; 0
ITEM DESCRIPTION i 1f=)i _t. ,_.T.Y FEF AMOUNT
:i:NY,::'Et:::TION FEE 2 10C,,00
STATE SURCHARGE 4COUNTY SURCHARGE
PERMIT T'Y?='i..: FEE AMOUNT AMOUNT NT 'rI"AMOUNT OWING
PHONE=
MOBILE Fl ami::: PMT 120,50
t')
PR c .'Tt) EL, GLORIA
F1:.1:rJTF:T) ' ...t : WEi,lT)Ei... GLORIA
:++: i+: P; •N: 3+: •H: R• Yt•'it 3 •x• * •x•3*.:,k 3. 1f •x- 14- •x
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,, !�4•i 'i ::. 4.) ., ..111
3 3.3 :_: if 3 .x. 3.3 .x. 3..h. * 9E -x ii: 3 3: 3* # •i+; 3* * 3* 4 i r: }::u .,.:j;.