1981, 09-03 Permit: 81A-8898 MHi✓
PLA R
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
JQB ADDRESS
1 OT" BLL OK SUBDI ON�1
ri K'6
OWNS
3 'C1'sIGiA A A. o 1)
ADD ESS} c�
CO cg tirf
ADDRESS i
4.
12-172- I
LEGAL DESCRIPTION - SEE ATTACHED
CEL NUMBER/S r52:51_ 51 C.9(! `
�
PARCEL
CPONE
Actual Set Backs in Feet
North S ci ISouth3'
East 'West ✓
Size of Parcel
9c)` 17-7
Zone Classificati
-•}4tn
�
ZIP
Ty pe,O
nst.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
ZIP
Main Floor
Upper Floors
Building Ac?jpC//7 . Ft.
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
CJ NEW ❑ ALT. ❑ AD'N. 0 RPL.
❑ BLD. ❑ PLMB. 0 MECH. �.H.
❑ MVE.
0
POOL
0 OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. f
VAL TION SOURCE
OF
UTILITIES
9. ICP/ 1`l
(1 >70)
AS ELECTRIC
Enum. Dist. I Location (Area)
WATER
1:1. Ni
SEWER
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 INSPECTIO
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
7/
ire Marshall
SIGNATURE OF APPLICAN
SPECIAL CONDITIONS:
?/
Co. Engineer
Ues�
FEES COLLECTED
Single $
Building
Plumbing
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C'o
rrioAICa u?oAJ Rc.nt707: (xl`3774(7
/40036, Am_ 7//9/t/
m.uoto.c_c. so,4*(4,5,
Plans Examiner
SEPA Checklist
�ltding ian
y�l
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
PERMIT r4UMBEP.•
eIiq - aska.g
07*
*50.00
*50.00 N
889.72
0.9-03-81
z 6479.
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U
w
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
i•
09;: �0 ;
DATE ISSUED
81'
889,82 *50.000..
PERMIT NO. TOTAL
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