1981, 05-21 Permit: 81A-4992 GaragePLAN NUMBER
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. E. 5'"/Oa
kP,RR.iN6To i
LEGAL DESCRIPTION - SEE ATTACHED
LOT
2.
BLOCK
SUBDIVISION
OWNER •
3 RflL7t4
ADDRESS
E.' )a' NAaa1N]txroN
CONTRACTOR -
4.
SRmE
PHONE
PARCEL NUMBER/5 LS $a, 3 Vtl.93.eI /
EXt. N 951 RM(:\t,1LnTLn.s ADD' la Nu1CI4,
125544-113o
ZI P
Actual Set Backs in Feet I
North 'South Z5 East 62; IWest
PHONE
Size of Parcel Zone Classification
tub 1i3 MA, sue3 Af:1ATJ
ADDRESS •
SAMC_
ZIP
TyConst.
Occupancy
Al -1
Sprinklered
❑Yes ❑No 0 Rec'd.
DESIGNER
PHONE
Valua on
1;1L1,
Building Area in Sq. Ft.
2$F,
ADDRESS
ZIP
Main Floor
Upper Floors Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement'
TYPE
7. OF
WORK
110/NEW 0 ALT.
BLD. 0 PLMB.
❑ ADN.
O MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
0 OTHER
No. Baths
NO. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
DESCRIBE WORK
8. '�eTf1�ilEQ 6AilpoF_ k,/_., A134
Enum. Dist.
LReq'd.
Location (Area)
%ALUATI ON
9.. 112.2.
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 . l /��/6 / SIGNATURE OF APPLICANT
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
5crnC
Ownersh IP
Public 0 Private
USE CODE
SPECIAL APPROVALS
NAME DATE
E v. ealth
arming
a//
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
Mot RE4t*
SEPA Checklist
Bulltl Technician
SPECIAL CONDITIONS:
• PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
No7 eq'd.
FEES COLLECTED
Single $
Building 41.00
Plumbing
Mech.
Plan Check
SEPA
Mobile Horne
Other (Specify)
TOTAL $ Z.C14
PGR M IT
8I%-4k�Z- :
0;2* *2900
*2900 17)
499.;1
05'21 -8,1
g 6.4 7 9,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE'ISSUED '
PERMIT 4199.212 *12'9TOOOTTALF
1
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