1982, 11-01 Permit: 82B-0478 SidingrA—NN UMBER APPLICATION/ PERMIT PERMIT NUMBER
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 DDRESS ,
LEGAL DESCRIPTION — SEE ATTACHED
LOT I BLOCKISUBDIVISION-PARCEL NUMBER/S
2.
OWNER' `HONE
3. t -54
? -4434-3-
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1 <r
Ca i r`
A DRESS
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Actual Set Backs in Feet
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14 1 i — C' (1
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North South
East West
CONTRACTOR
PHONE
Size of Parcel
Zone Classification
' t"
—
4. ADDRESS
ZIP
Type Const.
Occupancy
Sprinklered
q j,c,
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation � B°e
l
Building Area in Sq. Ft.
5'
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
_
CHANGE OF USE FROM
TO
Area of Decks Finished Basement
Unfin. Basement
6.
I
No. Baths
No. Stories
No. Rooms
No. of Dwellings
TYPE ❑ NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
�, OF OTHER
1:1BLD. ElPLMB. ElMECH. ElM.H. ❑ POOL
CERTIFICATE
Req'd.
Recd.
Not Req'd.
WORK
of EXEMPTION
DESCRIBE WORK
Enum. Dist.
Location (Area)
FEES COLLECTED
8.
VAL"I�SOURC
ELECTRIC
WATER
SEWER
Ownership
USE CODE
9. Q
OF
Public ❑Private
❑JTILITIES
Single $
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
Building
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
Plumbing
o
DATE OF APPLICATION SIGNATURE OF APPLICANT
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
NAME DATE
Plan Check
Env. Health
SEPA
i
Planning
Mobile Home
1
Fire Marshall
i
Co. Engineer
Other (Specify)
Utilities
c�
TOTAL $C�tv��
Plans Examiner
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
THIS BECOMES A PERMIT.
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4 7. 8 z * 8 9' O O
6 ch cin /
PERMIT IS NONTRANSFERABLE
11" _
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