1982, 10-21 Permit: 82A-9930 Fire Damage RepairPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY -,BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKAsJE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK BDIVI ON PARCEL NUMBER/S
OWNER
No. Baths
PHONE
�s
GC7�(�
3.
ADDRESS
ZIP
7, OF El OTHER
CONTTRRAyCTOR
yPHONE
`5
aj t L40
CERTIFICATE
Y
4' ADD
ESS
Z.LP
•
DESIGNER
PHONE
5.
I
ADDRESS
ZIP
CHANGE OF USE FROM
TO
s.
FEES COLLECTED
Actual Set Backs in Feet 1
lorth (South
ize of Parcel
Tj o 2p
TypejCpist. Ok- p' ncy
n Floor I Upper
ecks
Zone Classification
�Ia* I� red
❑Yes ❑No ❑ Req'd.
Building Area in Sq. Ft.
Garage Area Storage
asement I Unfin. Basement
PERMIT NUMBER
TYPE
No. Baths
No. Stories
No. Rooms
No. of Dwellings
❑ N W ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
7, OF El OTHER
lQ BLD. ❑ PLMB. ❑ MECH. ❑ M.H. EI POOL
CERTIFICATE
Req'd.
Recd.
Not eq'd.
WORK
of EXEMPTION
I
DESCRIBE WORK
00
Enum. Dist.
Location (Area)
FEES COLLECTED
8
VQ DATION
SOURCE
GAS
ELEC RIC
WATER
SEWER
Ownership SE CODE
9. ✓
UTILOITIES
Public ❑ Private
Single $
1 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
Building
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
Plumbing
s`^
DATE OF APPLICATION—/O �j —� SIGNATURE OF APPLICANT
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS:
NAME DATE
Plan Check
Env. Health
SEPA
Planning
Mobile Home
Fire Marshall
Co. Engineer
Other (Specify)
Utilities
TOTAL $�
Plans Examiner
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist
THIS BECOMES A PERMIT.
1'0 ` 2'' 8 2 9 9 3. 0 z � 2'4 0, 0 0 2 IJ— —
uil e clan �,� PERMIT IS NONTRANSFERABLE