1985, 02-14 Permit: No# Insert."•1/PLAN NUMBER
V' 1
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 4563675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB 1.
O
LTA� BLOCK ISUVI
BIIIONE
(56
2. -/(0 2 I 08552_ 2- — /5/h
LEGAL DESCRIPTION — SEE ATTACHED
OWNER
3 Mt2D. \J P .) Pc \NC%
,ADDRESS
6. i Si�Acf Cir
ONTRAC OR
4.
gEo• 7v
P
PARCEL NUMBER/S
oaeh Csfd's
Actual Set Backs In Feet
North 'South East (West
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
R
\), 3a`ua
DESIGNE
5.
4990149,
Type Const.
Occupancy Sprinklered
Oyes ❑No ❑ Req'd.
PHONE
Valuation (Building Area In Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE 0 NEW
7. OF
WORK 0 BLD.
❑ ALT. r❑ O N. 0 RPL. 0 MVE.
❑ PLMB. LJ 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.
DESCRIBE WORK
S.
VALUATION
9.
SOURCE
OF
UTILITIES
ELECTRIC
WATER
SEWER
Enum. Dist.
Location (Area)
Ownership
Public ❑Private 0
USE CODE
I hereby certify that 1 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 IocalJ�aw regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECiiICNS
DATE OF APPLICATION.
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
4.3EPA.Checklist
• �7
BulldtpQ Technlclan
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
II
"
9'
Ors_ 'Th .ti • iinntri d
Li NS•t I ilunAh; 1 E uxse R-6-11;
6-Q;
ciWP
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
22 "-
0,qs5116502
%.3&/
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED PERMIT NO.
TOTAL