1982, 05-28 Permit: 82A-4346 MHPLAN NUMBER
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APPLICATION/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
1.
JOB ^e DDRESS �� q,��
4" No7 61P-16Cal) j�1v
LO BLOCK SUBDI IS1ON
2. 3 �MIII ' uI0r/i�y{�s�f[,1y54 ova
r�, 1,,FQ��NEJ
3. OWI YI✓flc ✓K014 Oft elf `I\- 1RAI ova PI /J 566z -
ADDRESS I o k_0
1,00
DO NT RA CTDR �-1/
4.
SAN 1�
ADDRESS
Z P
PHONE Ce
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER/S 55 2_ — 0503
Actual Set Backs in Feet
North 'South 67
East (West
Size of Parcel
72 c '4-4
ZIP
Typd 4onst.
Zone o Classificati
R1�. PI • 1.01
cct panty
Sprinklered
Oyes 0No 0 Req'd.
5.
DESIGNER
PHONE
Valuation
. I 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
7. OF
WORK
LJ NEW 0 ALT. 0 AD'N.
❑ BLD. 0 PLMB. 0 MECH.
m0 RPL.Q H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req,d.
Rec'd.
Not q'd.
DESCRIBE WORK
8. Heti Lt
Enum. Dist. I Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private
/GSE 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. Health
i
Planning
Fire Marshall
EngI er
INN
Ut ties q
Plans Examiner
SEPA Checklist
• Tat
ea SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
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SxJr2-c is r is c0y1/4,ssjw.c1-'S. vakiQ
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C WS_w-off 1 or Gyro, .0.5( -1-Q4 .•-o_va&
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
50
TOTAL $
50
PERMITaxe, BEH4-3Tw
02* *50.00
* 50,00 t5
* 50,006
A ' t*000 8
43028
b 28L82
g 6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT. I,
'01;5 jR,8rti 4•3'4:6 Z. *:5.QO:Ol�
DATE ISSUED PERMIT NO. TOTAL
7)' 90'
52'
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