1981, 01-16 Permit: 81A-534 Residencew1
PLAN NUMBER
e/A'-
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'r (I'
1 LOT BLOCK SU�IVISION
2. •
OWNER a4_
3. 45/‹.4, lnr
DRESS NI
ONT.RAt°CTOR R A62.3'
C
rel
ADDRESS
LEGAL DESCRIPTION — SEE ATTACHED
4.
l
�c'_ n sv
PHONE
,'' 6 .-e)-FSIs
ZIP
c ca0C,
PARCEL NUMBER/S
„T_, �-.s <...57716— icy ./
�" - ,7/'t
Actual Set Backs in Feet /
North 2.4 / (South
East
, /
'West�7�
PHONE
Size � ofrParcel
/CG% /,S L'
ZI P
Type Const.
Fr. S–N'
Occupancy
3F-.< R-,3
Zfe Classification
i.-,17--,
prinklered
❑Yes KNo ❑ Req'd.
DESIGNER
5.
ADDRESS
PHONE
ZIP
V `'ation
�51,ain Flo
D
or
r �19v
Building Area in Sq. Ft.
Upper Floors
Garage Area
h o2C:
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
/6C Cou,EREp
Finished Basement
Unfin: Basement
7c
TYPE
7. OF
WORK
VI NEW
❑ BLD.
❑ ALT. ❑ AD'N. ❑ RPL.
❑ PLMB. ❑ MECH. ❑ M.H.
❑ MVE.
❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
1
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WO5K
VALUATION SOURCE
iJ OF
TILITIES
Ciltj' GtJ/'
�' nC' N- �/ (L ' ,`!1 1.7C:e�
SernrLT
GAS ELECTRIC WATER
�P - tJ& f
SEWER
Enum. Dist.
Location (Area)
iJ
Ownership
Public ❑ Private ,
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 / — SIGNATURE OF APPLICANT -644 -473? -z--...4.)--,1
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env
Pldnning
Pi/Z) /1/9
Fire Marshall
nee s
Uti st
Plans Examiner
"j'oi'n Po s -T1 w} /)67/.4
SEPA Checklist
Building Technics
"APPROACH PERMIT FEQTRED"
Contact County Engineer's i tfice
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
/.3av
TOTAL
PERMIT NUMBER '�
02* *31300
*313.00
*313.006
A *0.00 0
3898
01-13-80
g 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
01716. 81
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
5 142 *3.t3.00,�
PERMIT NO. TOT L
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