1981, 12-10 Permit: 81B-2618 InsertPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESY HARD TO MAKE 3 -COPIES
1.
2.
3
JOB ADDRESS
i13S2-o a. MAX WEAL
LEGAL DESCRIPTION - SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNER
Gev.ALD Scbt&H
PHONE
R2(-ln$
PARCEL NUMBER/S
ADDRESS
t 862 a". NtXvrELs-
4ZIP
1D%CD
4.
CONTRACTOR
SAONE
PHONE
ADDRESS
ZIP
5.
DESIGNER
PHONE
ADDRESS
ZIP
Actual Set Backs In Feet
North 'South East (West
Size of Parcel Zone Classification
Type Const. Occupancy Sprinklered
❑Ves ❑No 0 Req'd.
Valuation Building Area in Sq. Ft.
Main Floor Upper Floors Garage Area Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unf in. Basement
TYPE 0 NEW
7. OF
WORK 0 BLD.
❑ ALT.
❑ PLMB.
❑ AD N.
❑ MECH.
O RPL.
O M.H.
O MVE:
O POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
DESCRIBE WORK
8.
InsiALL- Pi vs
CB TnS6.f2.'t"
Enum. Dist.
Location (Area)
VALUATION
9.
SOURCE GAS ELECTRIC
OF
UTILITIES
WATER
SEWER
Ownership
Public 0 Private 0
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
,42DATE OF APPLICATION l / "CV e/ SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
. Builth•• Tp�.11M PERMIT IS NONTRANSFERABLE
fl PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
SIB 2Ccl&
04*
* 17.0.0
* 17.00 65
* 17.006
*000
261.72
12-10-81
2. 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE ISSUED
2'6i8'Z' .*'17.00a�
PERMIT NO. TOTAL
>-
0-
WHEN
-