1981, 02-05 Permit: 81A-1188 Repair Fire DamagePLAN 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.1011C Ales on
LEGAL DESCRIPTION — SEE ATTACHED
LOT
2.
BLOCK
SUBDIVISION
OWNER
3 30,3 RAt31 iia a
ADDRESS
E.IDl15 Mr:A/o")
PHONE
PARCEL NUMBER/S EV2. of L1) 1'75 of `J' Yz Er -C.
IU. ISt dPattunitr/ ?nu or fSLC Sit
ZIP
aCiZoto •
Actual Set Backs in Feet_
North South East
(West
CONTRACTOR
4 'tRutaEET Cot'V3TQLIGTtor0
ADDRESS
-a. tsoe 'Patina
PHONE
fg—c5Ct11
Size of Parcel 1 Zone Classification
ZIP
41267
Type Const.
Occupancy
12.3
Sprinklered
Dyes DNo 0 Req'd.
5.
DESIGNER
PHONE
Val ation
Building Area in Sq. Ft.
ZCC)
ADDRESS
c•
ZIP
Main Floor
Upper Floors 1 . Garage Area
Storage
CHANGE OF USE FROM
6:
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE 0 NEW
7. OF
WORK BLD.
DESCRIBE WORK
8• `Rc9A e. RttE
VALUATION
2 1c5rODn
O ALT.
O PLMB.
❑ AD N.
O MECH.
21 RPL.
0 M.H.
0 MVE.
❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
R eq'd.
. Rec'd.
Not Req'd.
Enum. Dist.
1tA1'Vt Par
Location (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership
Public 0 Private
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.�SEEREVERSESIDE FOR REQUIRED INSPECTIONS��
DATE OF APPLICATION 2-- / `- SIGNATURE OF APPLICANT 'Mt
SPECIAL APPROVALS
NAME PATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
\ b -t 12L&
SEPA Checklist
Budc4141 TBuildin Te/chniciiaan_x/
T J cl
SPECIAL CONDITIONS:
Vni_41F : 4 — 14) KLOCJL .,OtSTS
fLoo2 SIT. Set n.)G
—012o,/ LOrALL_
f 1 nit 5 1/0c ez c
PERMIT 1S NONTRANSFERABLE -
FEES COLLECTED
Single $12_23‘00
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home '
Other (Specify)
TOTAL
PERMIT NUMBER
8)4-11n8
02* *12800 .
* 12800
* 128.006
A *Q00
118.72
02-05-8,1
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
02;.:'Di5'!-8,i1!' l;las'z *1218,0.0:44
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE _ DATE ISSUED PERMIT NO. TOTAL