1981, 05-27 Permit: 81A-5145 MHPLAN NUMBER
5-7//0/ 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. E.. 10)T
511k
LEGAL DESCRIPTION - SEE ATTACHED
LOT
2.
BLOCK
SUBDIVISION
3.
OWNER
1 f?. V -1D A\> i i
PHONE
G� .1302—
PARCEL NUMBER/5 LANE.E. `]t L7FLt>T.3I
ALL LbTS 32 % 33 1?)LICI
?4 -ft -2.51'?
ADDRESS •
L_ .. t-1�� wFI._F;Lf_=`i
ZIP
Actual Set Backs in Feet
North (South L Z East
I
West 1 !-
4.
5.
CONTRACTOR
ADDRESS
�Ati'IC
DESIGNER
PHONE
Size of Parcel
G,'; X12:1
Zone Classification
ik';. ll1.CA iLI.. i t
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Val tion I Building in Sq. Ft.
ADDRESS
ZIP
Main Floor
3
67
Upper Floors 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
00 NEW ❑ ALT. ❑ AD'N.
❑ BLD. ❑ PLMB. ❑ MECH.
0/RPL. ❑ MVE.
M.H. ❑ POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
4
No. of Dwellings
(
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not1,q'd.
DESCRIBE WORK
8. 15 N1.)(..)
L1214
VALUATION
91 [LI' COO
"t Uo IL 14[)11IC (1VIA)
Enum. Dist. I Location (Area)
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
Y tL
Ownersh ip
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 s� —C72 ')
SPECIAL APPROVALS
NAME DATE
nv. Health
(?t, 4,
Planning
Fire Marshall
Co. Engineer n
o
•
Utilities
Plans Examiner
SEPA Checklist
B In
ech nicia
7
G
SIGNATURE OF APPLICAN
SPECIAL CONDITIONS:
Ext -5-f• c. ` cp-riic
gx (Sri NCI
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home—'v'���
Other (Specify)
TOTAL $ ti • 06
PERMIT Nl N—I6ER
ells X145
07* *56.00
*50,00
51[(.42
05-27-81
6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
l'?" 81'
5; : Z 514 5 =
DATE ISSUED PERMIT NO.
*5QOOa�
TOTAL
5CPTLC- L LIVES AR{¢cn• LOCA. -Et Ord
65'
isi