1981, 10-03 Permit: 81B-0603 MHPLAN 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
2.
3.
LOT
E. ler -.)..o -R,vc v\llky
BLOCK SUBDIVISION
LEGAL DESCRIPTION - SEE ATTACHED
OWNER
ADDRESS
9.5" C. l`Jr
PHONE
PARCEL NUMBER/S CJ,2z�iv 0-6� IC.' Z• fit` ' ''�
exc.. Shy:. ...)-.SL;
ZIP
4.
5.
CONTRACTOR
t
ADDRESS
DESIGNER
PHONE
c� 1�y4 -c;��L
Actual Set Backs in Feet
North South ''56
Size of Parcel
.'2.5
East 30 IWest
Zone Classification
146T2 t(�.0 -ra,(ZP L
ZIP
Type Const.
Occupancy
Z3
Sprinklered
❑Ves ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ct�
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
NEW ❑ ALT.
❑ PLMB.
❑ BLD.
TO
Area of Decks
Finished Basement
Unfin. Basement
❑ AD'N.
❑ MECH.
❑ RPL.
M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE VORK
8. Stn;�
VALUATION
Enum. Dist.
tNc.�w (i4 c'7o)
Location (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Ownership 1
Public ❑ Private le
i
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
SPECIAL APPROVALS
NAME DATE
r1c: 1?.e.,c iJ
Fire Marshall
Co. Utilities
Plans Examiner
SEPA Checklist
Build
ng Technician
<.
SIGNATURE OF APPLICANT'
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE. SS11E�1
t +� 3,1— rl
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home*'SC E
Other (Specify)
TOTAL
$
PERMIT N�MBER
Oc c3
07* *5000
* 5000 16
* 50.006
A *0.00 g
6Q�<
10-13-81
6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
PERMITNO*519
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