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1981, 10-13 Permit: 81B-642 Insert
PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER SPOKANE COUNTY - BUILDING CODES DEPARTMENT B/B''" 6 4+2„ NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509)456-3675 (1 APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES JOB ADREss C U * * 1 7 00 1. N. DDDR Woo17 SAWN LEGAL DESCRIPTION — SEE ATTACHED * 1 7 Ci C LOT BLOCK SUBDIVISION PARCEL NUMBER/S * 1 ,.ICC cy 2. OWNER PHONE 3 POU.CY S HER Y WN c'2 -7663 ADDRESS ZIP Actual Set Backs in Feet Q, N- 612_ 1,000D LAWN 132.)6 North 'SouthEast (West 1 0- 1 3- 1 CONTRACTOR PHONE Size of Parcel Zone Classification 4. 3A4 6479, ADDRESS ZIP Type Const. Occupancy Sprinklered ❑Yes ❑No 0 Req'd. DESIGNER PHONE Valuation Building Area in Sq. Ft. 5. ADDRESS ZIP Main Floor Upper Floors Garage Area Storage — CHANGE OF USE FROM TO Area of Decks Finished Basement Unfin. Basement 6. TYPENo. Baths No. Stories No. Rooms No. of Dwellings 0 NEW 0 ALT. 0 AD'N. 0 RPL. 0 MVE. 7, OF 0 OTHER WORK I: BLD. 0 PLMB. 0 MECH. 0 M.H. 0 POOL CERTIFICATE Req'd. Rec'd. Not Req'd. of EXEMPTION DESCRIBE WORKEnum.Dist. Location (Area) FEES COLLECTED 8. -F112PPLAc£ iNSE-42---T" taro-r niPtsomey nizisl'LAGE. VALUATION SOURCE GAS ELECTRIC WATER SEWER OF Ownership USE CODE 9. UTILITIES Public 0 Private 0 Single $ 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 ordin. ce ,.verni g this type of work will be complied with whether specified herein or not. The granting of a pe I goes o��-.r-:. . Building to give authority to violate or cancel the provisions of any other state o •ca la, regul. • cons u.+'.; . e performance of construction.SE REV R E SIDE FOR REQUIRED 'SPECTION• / Plumbing / ��,i oo J DATE OF APPLICATION SIGNATURE OF A PPLICAV-:aIi.1!511 Mech. 7- SPECIAL APPROVALS SPECIAL CONDITIONS: NAME DATE Plan Check Env. Health SEPA Li. Planning ('D Fire Marshall Mobile Home L I-SSGtE Co. Engineer Other (Specify) I© XX: Utilities CO + TOTAL $ I Xb Plans Examiner WHEN MACHINE VALIDATED IN THIS SPACE, SEPA Checklist THIS BECOMES A PERMIT. Building Technician PERMIT IS NONTRANSFERABLE i o o - 1�'0 ,� 3 -8'1 6422 *17.00a � PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL