1982, 05-21 Permit: 82A-3996 AdditionPLAN NUMBER
APPLICATION/PERMIT
ON/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
r S
\ r-
LEGAL DESCRIPTION — SEE ATTACHED
LOT
2.
BLOCK
SUBDIVISION
OWNER
3. (&i Fr'ok24C-�
ADDRESS
Com, 1�t7.�
CONTRACTOR
4' ADDRESS
OrJ
PHONE
c .4• -C A.1414-
PARCEL NUMBER/S tAith f2"St•r-i 1�r+rV'�; L I•Z
1_i✓ C G `r RI . VII' c t tAit 2 tic ter : a L;j
•24 S44 -.sem
ZI P
Actual Set Backs in Feet
North ISouth°24.1.45-:-."East,
'West
PHONE
Size of Parcel
t 5C�
Zone Classification
ZIP
Type Const.
N
Occupancy
t
Sprinklered
Elves ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
+�33
Building Area in Sq. Ft.
s
ZI P
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
iEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ OTHER
BLD. ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not
DESCRIBE WORK
8. Pht-2 ,-rt.or-74 tlIsk
VALUATION
9.
SOURCE
OF
UTILITIES
Cli
GAS ELECTRIC
Enum. Dist. I Location (Area)
WATER
SEWER
"prt C_
Ownership
Public ❑ Private 11/
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
DATE OF APPLICATION ( SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Plannin
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building 7
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ 76
PERVIT. NUii.-BER
52A 3(1%
02* *75.00
*7500 re
*75.006
A *0.00
399,5
05-21-82
647`c;
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
05-21-82
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
3 6 * / TO
PERMITNO.TAL