1981, 07-31 Permit: 81A-7669 MHPLAN NUMBEK ;71
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
1LOT BLOZIK SUBDIVISION
Are -)-1‘1°
LEGAL DESCRIPTION - SEE ATTACHED
3.
4.
NER
PA /1 Ac.;
A D D RSS I 3 -.61,AsoV VI
CONTRACT RR
PHONE
PARCEL NUMBER/S 17�Z I / I
Actual Set Backs in Feet
North (South. -4, 1East
Size of Parcel
ic,
LWest,3.4/
Zo a Classificatio
,i ,4.
ADDRESS
ZIP
Typ Cpnst.
VN
Occupancy
fL-
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin_ Basement
TYPE
7. OF
WORK
M/NEW ❑ ALT. ❑ AD'N. 0 RPL. 0 MVE.
0 BLD. ❑ PLMB. ❑ MECH. 'M.H. 0 POOL
DESCRIBE WORK
c
VALIDATION
9. .�
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
SOURCE GAS
OF
UTILITIES
ELECTRIC
WATER
V
0 OTHER
SEWER
f70.11 -
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Enum. Dist. I Location (Area)
Ownership
Public ❑ Private
USE CODE
Req'd.
DATE OF APPLICATION 7hC(
SPECIAL APPROVALS
NAME DATE
En 7ealth
d-e:"fit 7/�3 /
Planning
Fire Marshall
Co.ngineer
141' .pI!.
Utilities
Plans Examiner
SEPA Checklist
Bui 'ng #e ni ian
SIGNATURE OF APPLICANT `.0 -kW -I ] • .)CI( IQ
SPECIAL CONDITIONS: e
is .app &tom C?k rn (Ir •
$
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Rec'd.
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
ech.
Plan Check
SEPA
Mobile Home
Other (Specify(
TOTAL $ � � ()
PERMINUr1c7ER
P, )4 -
07* * 1 00.00
*100.00 t
*100.006
A *000 0
75608
07-2881
g 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
7 `91913Y- 4.
!8'1
DATE ISSUED
tI
7669z *i10O.008),P
PERMIT NO. TOTAL
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