1981, 12-28 Permit: 81B-3012 MH.AN NUMBER
VI
0,•
{ / s
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
JOB ADDRESS
1. tJ. IS 1S G RA:0,-/
BLOCK
LOT
2. 2
LEGAL DESCRIPTION - SEE ATTACHED
SUBDIVISION
MISS1da tf iS'TA
OWNER
a OeNS EI�Sf.1
ADDRESS
( tamps LLUtS2y , &?RflrrOACa6b
CONTRACTOR
4.
5.
ADDRESS
`JPYvIC
DESIGNER
PHONE
PARCEL NUMBER/S
- Tiv of t-ISSa.-
ZIP
O,4o
Actual Set Backs in Feet
North' 20/ (South A4- East �O (West
PHONE
Size of Parcel
78.4x t4o,11
Zone Classification
rrstT
ZIP
Type
r Const.
Lr n+
Occupancy
923
Sprinklered
❑Ves ❑No 0 Req'd.
PHONE
Va�l ,@ ti -on
100 0
Building Area in Sq. Ft.
124
ADDRESS
ZIP
Main Floor
43.4 -
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unf in. Basement
TYPE
7. OF
WORK
ANEW 0 ALT. 0 AD N. ❑p PL. 0 MVE.
❑ BLD. 0 PLMB. 0 MECH. L•J M.H. 0 POOL
0 OTHER
No. Baths
t
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Re 'd.
Not R9q'd.
DESCRIBE WORK Moine,
c
8. c5r t Aa Lch OE, Mots E: rnF,
VALUATION
lti7co
SOURCE
OF
UTILITIES
GAS ELECTRIC
Enum. Dist.
C t4,croC
Location (Area)
WATER
SEWER
Scprit
Ownership
Public ❑ 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 (�J��n
,(CATION SIGNATURE OF APPLICANT �: (il XVA 1 ,�'e/f'�a
DATE OF APP)
SPECIAL APPROVALS SPECIAL CONDITIONS:
•SJAME DATE
Env. Health
Planning
Fire Marshal
Co. Engineer
es
Plans Examiner
SEPA Checklist
B
g T chnician
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home S0'0O
Other (Specify)
TOTAL $'SO .00
PER :>},yq ER
6113 - 3012
07* *5Q00
*50.00 L
'2986'2
1 2-24 -8'1
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
3''0.2.2 *50.002.0 -
11,` SE ; 811
DATE( 'ISSUED
PERMIT NO. TOTAL
.-_.-n_i- _ . ;u
P 1'$.,
/ LAA
e
_
� - r
Mt; t' a .-&'-t-AL
fJ