1981, 04-13 Permit: 81A-3463 RemodelPLAN NUMBER
e- 5/A- iv
aAPPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE.4 COPIES
`5573/ r/
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 4563675
JOB ADDRESS
1. %J. / `l t) 2 e.//l!'��Alir�
LEGAL DESCRIPTION - SEE ATTACHED
LOT 1 BLOCK
2.
SU�jDIVIS I
/�! CTR.(/
araita
3.
OWN
ADDRESS
�.tyt7 7n ..&. /.
PHONE
9z8-S.lo 2
ZIP
.9 Asti
PARCEL NUMBER/S
/ss-: y/- D7oG
Required Set Backs in Feet
r
North SI 'South U, East 2 5' !West 3.0
4.
5.
CONT A OR
PP.,HONE
-G o 4 0
Size of Parcel - i
Xa3O
ADDRESS
DESIGNER
2�ffzo642
Type�1Const.
71.S..rni
PHONE
Occupancy
Valuation I Building Area in Sq. Ft.
Zone Classlflca Ion
Sprinklered
gv❑Yes ❑No ❑ Req'd.
ADDRESS
ZIP
OWL Area Basement Area r Garage Area
Storage
CHAN9E OF USE FROM
6. O,. teal
TO Q ^
Split Entry
Split Level
Rancher
7.
TYPE
OF
WORK
❑ NEW 0 ALT. AD N. ❑ RPL. ❑ MVE.
0 BLD. ❑ PLMB. 0 MECH. 0 M.H. 0 POOL
0 OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Re d.
DESCRIBEyJ°RIt
8.
t 414-4-1/414-, da -44
VALUATION
9. 7 n -v
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
1 hereby certify that I have read and examined this applica ion and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correc . 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.
DATE
0 /
SIGNATURE 91
DEPT.
SPECIAL APPROVALS
REQ'D. RECD.
Env. H�Ith
v'(
Kral° •
Planning
Fire Ma shall
Co. Engt /Ceq10
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
cat(
J( 14C • `�10-141J- SI3-A-333c 7)
1,01'%81
MAIL- ‘-'10 OVJNI
DATE
7 APPRI ` i' ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
r ' )
PERMIT NUMyra
8 Ik --
DATE 7/t8 /
0'2* *4400
*44.00 N
*44006
A *Q00 8
-3251 2
04-08-8;1
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
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OWNER EP. MOSE s
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