1981, 12-11 Permit: 81B-2692 ResidencePLAN NUMBER . ..
eh, 5413
APPLICATION/PERMIT
SPOKANE COUNTY—aBUIibDING 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• 1t30G.. N.11 ¢csa
LOT BLACK SUBDIVISION
2. A3t� — 7S — 04-1
OWNER
3 4Aa-f
ADDRESS
S 'T2G2 rcc' .
LEGAL DESCRIPTION — SEE ATTACHED
PHONE
PARCEL NUMBER/S
61112- q0 -74 -
ZIP
aa.
Actual Set Backs In Feet II �
North 'South (East Sea (West
CONTRACTOR
4. S,sn c
ADDRESS
Sart
PHONE
Size of Parcel tQmss. Zone Classification
$4 3 iC.112-1CuL.TU2WL-
ZIP
DESIGNER
5' ADDRESS
PHONE
ZIP
Type Const. Occupancy
M
Sprinklered
OYes 0No ❑ Req'd:
I
V ation ' Building
ggArrea in Sq. Ft.
F501 1 lyea
Upper Floors Garage Area
Main Floor
tilde
Cp4G 484
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
ixs
Finished Basement
Unfin. Basement
Cti4
7.
TYPE
OF
WORK
NEW
BLD.
O ALT.
❑ PLMB.
O AD N. 0 RPL. 0 MVE.
O 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 Req'd.
DESCRIBE WORK ' .,L"
B. SINGLE. CPatL'1 ^'-<ESipc,vc.�. a(�e/atIE 14Trr c.0
[r��V�AALUATION
. W1
COD
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 construct}or the
performance of constructiy SEE REVERSE SIDE FOR REQUIRED INSPECTION /
SOURCE
OF
UTILITIES
GAS 1 ELECTRIC
WATER
Enum. Dist.
Location (Area)
SEWER
GPS C -
Ownership si USE CODE
Public 0 Private
DATE OF APPLICATION SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
:Faith
a ning
Fire Marshall
Co. Engineer
IIN�Si
12-14
Plan 6.lteyn er
1 1- st frt
SEPA Ohecklist
$eftym chnlcian
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building 4 2:.i.zi
Plumbing -
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $Cio
PERMIT NUMBER
g\a
02* *28600
* 28600 y
* 286006
A *000
260'02
12-09-81
2 64.79..
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
'17
tint'
,1� if
lI
DATE ISSUED
.1
2:6`9.2'g *2i86.00(TO
PERMIT NO. TOTAL
/-r 1177 rt
4, 0
go '
,,1 1000 c, dor)
geotY0
o
e-
0
-1 _J—
\c)
a
, 07)
5'
1
0
•
-X•
•
•
• , -
..-,:i.4titi,4:-C.-.,:!,;j0:1,7g;:"‘14,3 •
pn
,
'tkr