1981, 05-08 Permit: 81A-4500 ResidencePLAN NUMBER
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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
1.
JOB a DDRESS
5 k;hOro
2.
LOT
3
BLOCK
SUBDIVISIONAOC
LEGAL DESCRIPTION — SEE ATTACHED
OWN R
3. kJ k 711.{ C,
ADDRESS
`fieP�N'
CONTRA C5
4. ADDRESS
PHONE
28 '3(9t2
I Pg
PARCEL NUMBER/S 4i 03
PHONE
Actual Set Backs in Feet
North 'South 22 East
Size of Parcel
(West 1�
Zone Classification
4.1Q61, vitivt
ZI P
TyyelConst.
5.
DESIGNER
PHONE
Occup ncY
/M.1
Valuation
56E',
Sprinklered
❑Yes No ❑ Req'd.
Building Area in Sq. Ft.
ADDRESS
ZI P
CHANGE OF USE FROM
6.
TO
Main Floor
jQCo
Area of Decks
Upper Floors
Garage Area
2 P,
Storage
Finished Basement
U fin. Basement
Ba
TYPE
7. OF
WORK
'NEW ❑ ALT.
"BLD. ❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑POOL
0 OTHER
No. Baths
No. Stories
No. //F3ooms
`.O
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not7'd.
8.
DESCFAE WORK
Enum. Dist. I Location (Area)
VALUATION
9.
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
oT16
Ownership
Public ❑ Private V
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
,5 1
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
1•1/I'' 4 /1,-7 [51
Planning
Fire Marshall
Co. Engineer
6 -VA
Utilities
Plan< Examiner /
'ft raj'LG,Av K z fr vl
SEPA Check'ist
SPECIAL CONDITIONS:
mo( cAt c9 _ -re)f-
IJi2 i 1J - 11-- AeS4 .
y Rt.: -.C -1;E c I5/2„i /E3i
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building 1'77
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $ If,
PERMIT NUMBER
r� _"¢500
02* *31300
*31300 17,
*313.006
A *000 0
449.72
05-08-81
6479
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
05; 0I&, 81 450.02- *+31300
DATE ISSUED
-
a ►J -
PERMIT N0. TOTAL
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