1981, 02-17 Permit: 81A-1503 ResidencePLAN NUMBER 1 1-1
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
1. U 20 '
LEGAL DESCRIPTION — SEE ATTACHED
LOT
2. /t7
OWNER
3
4.
BLOCK
SUBDIVISION
eirZ.o 01..3X-3
PHONE
PARCEL NUMBER/S
oF-
�',a •Z CAE. L att 3 24-4/
cro rr- ?cf- 7
ADDRESS
CONTRACTOR
J i17L? &
ADDRESS
Z/
I�Pq
1Zo
Actual Set Back,s in Feet
North 1* 2E; 'South tO
t
East'
West
PHONE
Size of Parcel
ib`)X 1.5D
Zone Classification
ZIP
Type Const
-
Occupancy
1Z—/1!^-1
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
V ailea tion
Building Area in Sq. Ft.
ZIP
Main Floor
Upper Floors
Garage Area
L7397
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin- Basement
TYPE
7. OF
WORK
NEW
BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
E OTHER
No. Baths
No. Stories
'- L��FL
No. Rooms
LO
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd,
Rec'd.
Not Req'd.
DESCRIBE WORK
8. Si,Gt c L /—rlsf'(• iUi7V/,zt
VALUATION
SOURCE
OF
UTILITIES
GAS
E ECTRIC
Xcf1 i
9ls_ 1///S 4,4.8
WATER
a/4) P
EWER
Enum. Dist.
`Location (Area)
Ownership
Public ❑ Private Gi
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
E
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
1.Var LE 'b.
SEPA Checklist
Building Technician
SIGNATURE OF APPLICAN
SPECIAL CONDITIONS:
LADAL, t'3PIL
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$•;64-,o()
PERMIT NUMBER'
g/A - ADGL3
02* *304.00
*304.00
*304.006
A *0.00 d
15Q22
02-17-P1
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0 150.35 *304002i2
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
PERMIT NO. TOTAL
1
I .. I 1 1 Ili II III:111;111 III
S,91 AREA PER IM 11-9 Mr
1 1 1 1 1 1 1
III
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