1981, 04-28 Permit: 81A-4002 Remodel PLAN NUMBER APPLICATION/PERMIT PERMIT NUMBER
/623/$j SPOKANE COUNTY — BUILDING CODES DEPARTMENT g7A- 4e0Z
(1)„./ NORTH 811 JEFFERSON / SPOKANE,WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES * * 1 Ci 0 0
JOB ADDRESS LEGAL DESCRIPTION — SEE ATTACHED
LOT BLOCK SUBDIVISICq PARCEL NUMBER/S a+ �,5":3a _,
4.c5'�c7
* 1 r 0 0
=2. Ou/ o rOF 1-OT N. �3A-A /
PHONE {4. * U O C
E
s. �WA - � .3;36---?297 A°pc.ewAV N5/G1Ts o 0 1
ADDE-
ZIP Actual Set Backs in Fee
(`7, 4 323 7... e�. 3jp,e
4.4,fQ 99d0 North (south East west 0 4_ 2 8-8 1
C NTRACTOR PHONE Size of Parcel ; Zone Classification
.O L,) 711,A44-1•1/11,k& ,5-3,5--,154/6 -'OX if
RPA— il�! r,�.n-4a 6.4 7 9.
4' fAl DRESS / // yD �{0 ZIP
�i Type Const.Occupancy Spr nklered
(- . ,J /Q / 6,d„ 344-- q7z Eves ❑No 0 Req'd.
DESIGNER PHONE Valuation 00 Building Area in Sq. Ft.
5' ADDRESS ZIP Main Floor Upper Floors G rage Area Storage _
CHANGE OF USE FROM TO Area of Decks Finished Basement Unfin. Basement
6.
No. Baths No. Stories No. Rooms No. of Dwellings
TYPE 0 NEW 0 ALT. 0 AD'N. 0 RPL. El MVE.
7. OF X OTHER CERTIFICATE Req'd. Recd. Not Req'd.
WORK 0 BLD. 0 PLMB. ❑ MECH. D M.H. � 0 POOL ny
� ?��'TL ^/V/ Piv// of EXEMPTION X.
DESCRIBE W RK En um. Dist. I Location (Area) f
8 �P � 1 0 .����� IFEES COLLECTED
LUATIOfaI SOURCE GAS ELE��CT IC WATE1.1 .124--.
EWER Ownership USE CODE
O OF Public 0 Private
od UTILITIES single $
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included i O6 _
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing thisi
Building J
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 Plumbing
DATE OF APPLICATION SIGNATURE OF APPLICANT .Sir ., • i U i M• h.
SPECIAL APPROVALS SPECIAL CONDITIONS: e
NAME DATE Plan Check
Env. Health
SEPA z
Planning CD
C.)
Mobile Home "'1
J
Fire Marshall
U
Co. Engineer Other (Specify)
Utilities
TOTAL � ��
Plans Examiner
WHEN MACHINE VALIDATED IN THIS SPACE,
SEPA Checklist THIS BECOMES A PERMIT.
Bu"ding Tectimicia Y PERMIT IS NONTRANSFERABLE Q 141--2a''ri`8d: 4'0 a 2 *'4.a 0 0 °a h.
PA/ ciL2_24 / PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED PERMIT NO. TOTAL