1982, 02-09 Permit: 82A-924 RemodelPLAN 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
1.
2.
3.
4.
JOB DDRESSG�J �jY�'
LO BLOCK SUBDIVIS N
LEGAL DESCRIPTION - SEE ATTACHED
D A
ARE 1\4
CNyF}A TQR ✓�
ON
9.2046E
r
ZIP
PARCEL NUMBER/S ;✓✓� c4; i 1,0-4
Actual Set Backs in Feet 1,74 1:51114
North (South JEast 1West
PHONE
Size of Parcel 1 Zone Classification
ADDRESS
ZIP
DESIGNER
5. ADDRESS
PHONE
TygeNtonst.
Occupancy
Valuation r� Building Area in Sq. Ft.
Sprinklered
❑Yes ❑No 0 Req'd.
ZIP
Main Floor
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
TO
Area of Decks
Finished Basement
Unfin. Basement
0 NEW YA ALT. 0 AD'N. 0 RPL. 0 MVE.
'BLD. 0 PLMB. 0 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 R d.
8.
V,�L;sUATION
9. (;:e
DESCRIBE W RK (rAD
ELECTRIC
SOURCE
OF
UTILITIES
GAS
Enum. Dist. I Location (Area)
WATER
OwnershipUSE CODE
Public 0 Private
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 Fh, "/ / 4
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Heal h KM
1.
La
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
IO
SEPA Checklist
Buildin Te I ' n
SPECIAL CONDITIONS:
1\101- rAJva. nos
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 1
PERMIT NUMBER
* 6 1, 0 0
• 6
* 6100='
* J, i
023,
02-09— 2
6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0'Z,Ti19.' 8 2(
92,48 *6i1.00.a-12 -